Electrocardiography based prediction of hypertrophy pattern and fibrosis amount in hypertrophic cardiomyopathy: comparative study with cardiac magnetic resonance imaging.

PubMed

Park, Chul Hwan; Chung, Hyemoon; Kim, Yoonjung; Kim, Jong-Youn; Min, Pil-Ki; Lee, Kyung-A; Yoon, Young Won; Kim, Tae Hoon; Lee, Byoung Kwon; Hong, Bum-Kee; Rim, Se-Joong; Kwon, Hyuck Moon; Choi, Eui-Young

2018-05-04

Although, cardiac magnetic resonance imaging (CMR) is a gold standard for risk stratification of hypertrophic cardiomyopathy (HCM), is limited in some situations. We sought to evaluate the predictive power of quantitative electrocardiography in assessing hypertrophy pattern and fibrosis in HCM. Eighty-eight patients with HCM were studied. Voltage of R-S-T waves, number of fragmented QRS (fQRS) complexes, and T wave morphology were measured by 12-lead electrocardiography. Sixteen segmental thickness, late gadolinium enhancement (LGE), native T1, extracellular volume fraction (ECV), and T2, left ventricular (LV) mass and %LGE were measured by CMR. Patterns of LV hypertrophy were classified as pure apical, mixed, or asymmetrical septal hypertrophy. Positive and negative predictive values of biphasic T wave for pure apical type were 70.4 and 63.9%, and the predictive values of precordial negative T wave sums [Formula: see text] 12.5 mm were 69.2 and 79.6%. Precordial S waves, especially Cornell voltage index, were significantly correlated to LV mass index and maximal thickness (p [Formula: see text]0.001). The number of fQRS leads was significantly correlated to %LGE, average ECV, and T2 (all p [Formula: see text]0.001). More than one lead with fQRS could predict [Formula: see text]5% of LGE mass with 58% sensitivity and 63% specificity (p = 0.049, area under the curve = 0.627). However, degree of correlation between maximal thickness and precordial S was poor in cases with fQRS more two leads. T wave morphology and precordial S helps discriminate hypertrophy pattern and maximal hypertrophy, however, in cases with more than two leads of concomitant fQRS, CMR defines fibrosis amount and hypertrophy more accurately.

Analysis of the High-Frequency Content in Human QRS Complexes by the Continuous Wavelet Transform: An Automatized Analysis for the Prediction of Sudden Cardiac Death.

PubMed

García Iglesias, Daniel; Roqueñi Gutiérrez, Nieves; De Cos, Francisco Javier; Calvo, David

2018-02-12

Fragmentation and delayed potentials in the QRS signal of patients have been postulated as risk markers for Sudden Cardiac Death (SCD). The analysis of the high-frequency spectral content may be useful for quantification. Forty-two consecutive patients with prior history of SCD or malignant arrhythmias (patients) where compared with 120 healthy individuals (controls). The QRS complexes were extracted with a modified Pan-Tompkins algorithm and processed with the Continuous Wavelet Transform to analyze the high-frequency content (85-130 Hz). Overall, the power of the high-frequency content was higher in patients compared with controls (170.9 vs. 47.3 10³nV²Hz -1 ; p = 0.007), with a prolonged time to reach the maximal power (68.9 vs. 64.8 ms; p = 0.002). An analysis of the signal intensity (instantaneous average of cumulative power), revealed a distinct function between patients and controls. The total intensity was higher in patients compared with controls (137.1 vs. 39 10³nV²Hz -1 s -1 ; p = 0.001) and the time to reach the maximal intensity was also prolonged (88.7 vs. 82.1 ms; p < 0.001). The high-frequency content of the QRS complexes was distinct between patients at risk of SCD and healthy controls. The wavelet transform is an efficient tool for spectral analysis of the QRS complexes that may contribute to stratification of risk.

Analysis of the High-Frequency Content in Human QRS Complexes by the Continuous Wavelet Transform: An Automatized Analysis for the Prediction of Sudden Cardiac Death

PubMed Central

García Iglesias, Daniel; Roqueñi Gutiérrez, Nieves; De Cos, Francisco Javier; Calvo, David

2018-01-01

Background: Fragmentation and delayed potentials in the QRS signal of patients have been postulated as risk markers for Sudden Cardiac Death (SCD). The analysis of the high-frequency spectral content may be useful for quantification. Methods: Forty-two consecutive patients with prior history of SCD or malignant arrhythmias (patients) where compared with 120 healthy individuals (controls). The QRS complexes were extracted with a modified Pan-Tompkins algorithm and processed with the Continuous Wavelet Transform to analyze the high-frequency content (85–130 Hz). Results: Overall, the power of the high-frequency content was higher in patients compared with controls (170.9 vs. 47.3 103nV2Hz−1; p = 0.007), with a prolonged time to reach the maximal power (68.9 vs. 64.8 ms; p = 0.002). An analysis of the signal intensity (instantaneous average of cumulative power), revealed a distinct function between patients and controls. The total intensity was higher in patients compared with controls (137.1 vs. 39 103nV2Hz−1s−1; p = 0.001) and the time to reach the maximal intensity was also prolonged (88.7 vs. 82.1 ms; p < 0.001). Discussion: The high-frequency content of the QRS complexes was distinct between patients at risk of SCD and healthy controls. The wavelet transform is an efficient tool for spectral analysis of the QRS complexes that may contribute to stratification of risk. PMID:29439530

Diagnostic value of QRS and S wave variation in patients with suspicion of acute pulmonary embolism.

PubMed

Çağdaş, Metin; Karakoyun, Süleyman; Rencüzoğulları, İbrahim; Karabağ, Yavuz; Artaç, İnanç; İliş, Doğan; Hamideyin, Şerif; Karayol, Sibel; Çiftçi, Handan; Çınar, Tufan

2018-03-29

This study aimed to investigate the diagnostic value of QRS and S wave variation in patients admitted to the emergency department with suspicion of acute pulmonary embolism (APE). Computerized tomographic pulmonary angiography (CTPA) was performed in 118 consecutive patients to evaluate patients with suspected APE, and 106 subjects with appropriate electrocardiogram and CT images constituted the study population. Using CTPA, APE was diagnosed in 48.1% (n:51) of the study population. The comparison of patients with APE and those without APE revealed that increased heart rate, right axis deviation of QRS axis, complete or incomplete right bundle branch block, prominent S wave in lead D1, increased QRS duration, percentage of QRS (9,8[4,8-19,0] vs 3,8[2,7-71]; p<0,001), S wave variation (22,3[9,6-31,9] vs 4,8 [2-8]; p<0,001) and ΔS wave amplitude (1.1[0.5-1.5] vs 0.2[0.1-0.5]; p<0.001) were significantly associated with APE, but no relationship was detected with respect to the presence of atrial arrhythmias, clockwise rotation of the horizontal axis, fragmentation, ST segment deviation, T wave inversion, and S1Q3T3 and S1S2S3 patterns. The percentage of S wave variation (OR: 1072 per 1% increase, 95% CI:1011-1137) was found to be an independent predictor of APE. ΔS wave amplitude>0.5mm predicted APE with a sensitivity of 72.6% and a specificity of 74.6% (AUC:0.805, 95% CI: 0.717-0.876; p<0.001). The present study demonstrated that QRS and S wave variation could be useful electrocardiographic signs for the diagnosis of APE. Copyright © 2018. Published by Elsevier Inc.

Investigation of the fabrication mechanism of self-assembled GaAs quantum rings grown by droplet epitaxy.

PubMed

Tong, C Z; Yoon, S F

2008-09-10

We have directly imaged the formation of a GaAs quantum ring (QR) using droplet epitaxy followed by annealing in arsenic ambient. Based on the atomic force micrograph measurement and the analysis of surface energy, we determine that the formation of self-assembled GaAs QRs is due to the gallium atom's diffusion and crystallization driven by the gradient of surface energy. The phenomenon that GaAs is etched by the gallium droplets is reported and analyzed. It has been demonstrated that the epitaxy layers, such as AlAs and InGaP, can be used as the etching stop layer and hence can be used to control the shape and height of the QRs.

Functional, morphological and electrocardiographical abnormalities in patients with apical hypertrophic cardiomyopathy and apical aneurysm: correlation with cardiac MR

PubMed Central

Suwa, Kenichiro; Satoh, Hiroshi; Sano, Makoto; Nobuhara, Mamoru; Saitoh, Takeji; Saotome, Masao; Urushida, Tsuyoshi; Katoh, Hideki; Tawarahara, Kei; Ohtani, Hayato; Wakabayashi, Yasushi; Takase, Hiroyuki; Terada, Hajime; Takehara, Yasuo; Sakahara, Harumi; Hayashi, Hideharu

2014-01-01

Objective The prognosis of apical hypertrophic cardiomyopathy (APH) has been benign, but apical myocardial injury has prognostic importance. We studied functional, morphological and electrocardiographical abnormalities in patients with APH and with apical aneurysm and sought to find parameters that relate to apical myocardial injury. Methods Study design: a multicentre trans-sectional study. Patients: 45 patients with APH and 5 with apical aneurysm diagnosed with transthoracic echocardiography (TTE) in the database of Hamamatsu Circulation Forum. Measure: the apical contraction with cine-cardiac MR (CMR), the myocardial fibrotic scar with late gadolinium enhancement (LGE)-CMR, and QRS fragmentation (fQRS) defined when two ECG-leads exhibited RSR’s patterns. Results Cine-CMR revealed 27 patients with normal, 12 with hypokinetic and 11 with dyskinetic apical contraction. TTE misdiagnosed 11 (48%) patients with hypokinetic and dyskinetic contraction as those with normal contraction. Apical LGE was apparent in 10 (83%) and 11 (100%) patients with hypokinetic and dyskinetic contraction, whereas only in 11 patients (41%) with normal contraction (p<0.01). Patients with dyskinetic apical contraction had the lowest left ventricular ejection fraction, the highest prevalence of ventricular tachycardia, and the smallest ST depression and depth of negative T waves. The presence of fQRS was associated with impaired apical contraction and apical LGE (OR=8.32 and 8.61, p<0.05). Conclusions CMR is superior to TTE for analysing abnormalities of the apex in patients with APH and with apical aneurysm. The presence of fQRS can be a promising parameter for the early detection of apical myocardial injury. PMID:25332823

Recombinant expression, purification, and crystallization of the glutaminyl-tRNA synthetase from Toxoplasma gondii.

PubMed

van Rooyen, Jason M; Hakimi, Mohamed-Ali; Belrhali, Hassan

2015-06-01

Aminoacyl tRNA synthetases play a critical role in protein synthesis by providing precursor transfer-RNA molecules correctly charged with their cognate amino-acids. The essential nature of these enzymes make them attractive targets for designing new drugs against important pathogenic protozoans like Toxoplasma. Because no structural data currently exists for a protozoan glutaminyl-tRNA synthetase (QRS), an understanding of its potential as a drug target and its function in the assembly of the Toxoplasma multi-aminoacyl tRNA (MARS) complex is therefore lacking. Here we describe the optimization of expression and purification conditions that permitted the recovery and crystallization of both domains of the Toxoplasma QRS enzyme from a heterologous Escherichia coli expression system. Expression of full-length QRS was only achieved after the addition of an N-terminal histidine affinity tag and the isolated protein was active on both cellular and in vitro produced Toxoplasma tRNA. Taking advantage of the proteolytic susceptibility of QRS to cleavage into component domains, N-terminal glutathione S-transferase (GST) motif-containing domain fragments were isolated and crystallization conditions discovered. Isolation of the C-terminal catalytic domain was accomplished after subcloning the domain and optimizing expression conditions. Purified catalytic domain survived cryogenic storage and yielded large diffraction-quality crystals over-night after optimization of screening conditions. This work will form the basis of future structural studies into structural-functional relationships of both domains including potential targeted drug-design studies and investigations into the assembly of the Toxoplasma MARS complex. Copyright © 2015 Elsevier Inc. All rights reserved.

Aviation System Analysis Capability (ASAC) Quick Response System (QRS) Test Report

NASA Technical Reports Server (NTRS)

Roberts, Eileen; Villani, James A.; Ritter, Paul

1997-01-01

This document is the Aviation System Analysis Capability (ASAC) Quick Response System (QRS) Test Report. The purpose of this document is to present the results of the QRS unit and system tests in support of the ASAC QRS development effort. This document contains an overview of the project background and scope, defines the QRS system and presents the additions made to the QRS this year, explains the assumptions, constraints, and approach used to conduct QRS Unit and System Testing, and presents the schedule used to perform QRS Testing. The document also presents an overview of the Logistics Management Institute (LMI) Test Facility and testing environment and summarizes the QRS Unit and System Test effort and results.

Relation of QRS duration to mortality in a community-based cohort with hypertrophic cardiomyopathy.

PubMed

Bongioanni, Sergio; Bianchi, Francesca; Migliardi, Alessandro; Gnavi, Roberto; Pron, Paolo Giay; Casetta, Marzia; Conte, Maria Rosa

2007-08-01

A prolonged QRS duration on the standard electrocardiogram is associated with an increased risk of cardiovascular death in cardiomyopathies of different origin. However, the relation between QRS duration and prognosis in hypertrophic cardiomyopathy (HC) remains undefined. We assessed the relation between QRS duration and cardiovascular death in 241 consecutive patients with HC. The study cohort was divided into 2 groups according to QRS duration: <120 and > or =120 ms. Of the 241 patients, 191 (79%) had a QRS duration <120 ms and 50 (21%) a QRS duration > or =120 ms. During a mean follow-up of 7.9 +/- 5.1 years, 35 patients died of cardiovascular causes related to HC. Of these 35 patients, 13 (6%) had a QRS duration <120 ms and 22 (43%) had a QRS duration > or =120 ms (p <0.01). Risk of cardiovascular death was significantly higher in patients with a QRS duration > or =120 ms than in those with a QRS duration <120 ms (relative risk 5.2, p <0.0001). At 8-year follow-up, cumulative risks of HC-related death were 7.1% in patients with a QRS duration <120 ms and 55% in those with a QRS duration > or =120 ms. Multivariate analysis confirmed that a QRS duration > or =120 ms was independently associated with an increased risk of cardiovascular death (hazard ratio 3.2, p = 0.007). New York Heart Association functional class III/IV was the only other clinical variable significantly and independently associated with an increased risk of cardiovascular death. In conclusion, in patients with HC, QRS duration on standard electrocardiogram is directly related to cardiovascular mortality, and a QRS duration > or =120 ms is a strong and independent predictor of prognosis.

[Influence of the duration of recording in the reproducibility of the signal averaged electrocardiogram].

PubMed

Copie, X; Blankoff, I; Hnatkova, K; Fei, L; Camm, A J; Malik, M

1996-06-01

The authors studied the possibility of improving the reproducibility of the signal averaged ECG by increasing the number of averaged QRS complexes. One hundred patients were included in the study. In each cases, 400 QRS complexes were recorded on twice, consecutively, in strictly identical conditions. During each recording, the total duration of the amplified and averaged QRS complex (tQRS), the duration of the terminal signal below 40 microV (LAS) and the root mean square of the amplitude of the last 40 ms (RMS) were determined for 100, 200, 300 and 400 recorded QRS complexes. The presence of late potentials was defined as the positivity of two of the following criteria: tQRS > 114 ms, LAS > 38 ms, RMS < 20 microV. The number of contradictory diagnostic conclusions between two successive recordings of the same duration decreased progressively with the number of averaged QRS complexes: 10 for 100 QRS, 10 for 200 QRS, 9 for 300 QRS and 6 for 400 QRS complexes, but this improvement was not statistically significant. The absolute differences of tQRS and RMS between two successive recordings of the same duration were statistically different for the four durations of recording (p = 0.05) and there was a tendency towards statistical significance for LAS (p = 0.09). The best quantitative reproducibility of the 3 parameters was obtained with the recording of 300 QRS complexes. In conclusion, the reproducibility of the signal averaged ECG is improved when the number of average QRS complexes is increased. The authors' results suggests that reproducibility this is optimal with the amplification and averaging of 300 QRS complexes.

Early Changes in QRS Frequency Following Cardiac Resynchronization Predict Hemodynamic Response in Left Bundle Branch Block Patients.

PubMed

Niebauer, Mark J; Rickard, John; Tchou, Patrick J; Varma, Niraj

2016-05-01

QRS characteristics are the cornerstone of patient selection in cardiac resynchronization therapy (CRT) and the presence of left bundle branch block (LBBB) and baseline QRS ≥150 milliseconds portends a good outcome. We previously showed that baseline QRS frequency analysis adds predictive value to LBBB alone and have hypothesized that a change in frequency characteristics following CRT may produce additional predictive value. We examined the QRS frequency characteristics of 182 LBBB patients before and soon after CRT. Patients were assigned to responder and nonresponder groups. Responders were defined by a decrease in left ventricular end-systolic volume (LVESV) ≥15% following CRT. We analyzed the QRS in ECG leads I, AVF, and V3 before and soon after CRT using the discrete Fourier transform algorithm. The percentage of total QRS power within discrete frequency intervals before and after CRT was calculated. The reduction in lead V3 power <10 Hz was the best indicator of response. Baseline QRS width was similar between the responders and nonresponders (162.2 ± 17.2 milliseconds vs. 158 ± 22.1 milliseconds, respectively; P = 0.180). Responders exhibited a greater reduction in QRS power <10 Hz (-17.0 ± 11.9% vs. -6.6 ± 12.5%; P < 0.001) and a significant AUC (0.743; P < 0.001). A ≥8% decline in QRS power <10 Hz produced the best predictive values (PPV = 84%, NPV = 59%). Importantly, when patients with baseline QRS <150 milliseconds were compared, the AUC improved (0.892, P < 0.001). Successful CRT produces a significant reduction in QRS power below 10 Hz, particularly when baseline QRS <150 milliseconds. These results indicate that QRS frequency changes after CRT provide additional predictive value to QRS alone. © 2016 Wiley Periodicals, Inc.

Ventricular conduction and long-term heart failure outcomes and mortality in African Americans: insights from the Jackson Heart Study.

PubMed

Mentz, Robert J; Greiner, Melissa A; DeVore, Adam D; Dunlay, Shannon M; Choudhary, Gaurav; Ahmad, Tariq; Khazanie, Prateeti; Randolph, Tiffany C; Griswold, Michael E; Eapen, Zubin J; O'Brien, Emily C; Thomas, Kevin L; Curtis, Lesley H; Hernandez, Adrian F

2015-03-01

QRS prolongation is associated with adverse outcomes in mostly white populations, but its clinical significance is not well established for other groups. We investigated the association between QRS duration and mortality in African Americans. We analyzed data from 5146 African Americans in the Jackson Heart Study stratified by QRS duration on baseline 12-lead ECG. We defined QRS prolongation as QRS≥100 ms. We assessed the association between QRS duration and all-cause mortality using Cox proportional hazards models and reported the cumulative incidence of heart failure hospitalization. We identified factors associated with the development of QRS prolongation in patients with normal baseline QRS. At baseline, 30% (n=1528) of participants had QRS prolongation. The cumulative incidences of mortality and heart failure hospitalization were greater with versus without baseline QRS prolongation: 12.6% (95% confidence interval [CI], 11.0-14.4) versus 7.1% (95% CI, 6.3-8.0) and 8.2% (95% CI, 6.9-9.7) versus 4.4% (95% CI, 3.7-5.1), respectively. After risk adjustment, QRS prolongation was associated with increased mortality (hazard ratio, 1.27; 95% CI, 1.03-1.56; P=0.02). There was a linear relationship between QRS duration and mortality (hazard ratio per 10 ms increase, 1.06; 95% CI, 1.01-1.12). Older age, male sex, prior myocardial infarction, lower ejection fraction, left ventricular hypertrophy, and left ventricular dilatation were associated with the development of QRS prolongation. QRS prolongation in African Americans was associated with increased mortality and heart failure hospitalization. Factors associated with developing QRS prolongation included age, male sex, prior myocardial infarction, and left ventricular structural abnormalities. © 2015 American Heart Association, Inc.

The Shortest QRS Duration of an Electrocardiogram Might Be an Optimal Electrocardiographic Predictor for Response to Cardiac Resynchronization Therapy.

PubMed

Chen, Jan-Yow; Lin, Kuo-Hung; Chang, Kuan-Cheng; Chou, Che-Yi

2017-08-03

QRS duration has been associated with the response to cardiac resynchronization therapy (CRT). However, the methods for defining QRS duration to predict the outcome of CRT have discrepancies in previous reports. The aim of this study was to determine an optimal measurement of QRS duration to predict the response to CRT.Sixty-one patients who received CRT were analyzed. All patients had class III-IV heart failure, left ventricular ejection fraction not more than 35%, and complete left bundle branch block. The shortest, longest, and average QRS durations from the 12 leads of each electrocardiogram (ECG) were measured. The responses to CRT were determined using the changes in echocardiography after 6 months. Thirty-five (57.4%) patients were responders and 26 (42.6%) patients were non-responders. The pre-procedure shortest, average, and longest QRS durations and the QRS shortening (ΔQRS) of the shortest QRS duration were significantly associated with the response to CRT in a univariate logistic regression analysis (P = 0.002, P = 0.03, P = 0.04 and P = 0.04, respectively). Based on the measurement of the area under curve of the receiver operating characteristic curve, only the pre-procedure shortest QRS duration and the ΔQRS of the shortest QRS duration showed significant discrimination for the response to CRT (P = 0.002 and P = 0.038, respectively). Multivariable logistic regression showed the pre-procedure shortest QRS duration is an independent predictor for the response to CRT.The shortest QRS duration from the 12 leads of the electrocardiogram might be an optimal measurement to predict the response to CRT.

Mobile/android application for QRS detection using zero cross method

NASA Astrophysics Data System (ADS)

Rizqyawan, M. I.; Simbolon, A. I.; Suhendra, M. A.; Amri, M. F.; Kusumandari, D. E.

2018-03-01

In automatic ECG signal processing, one of the main topics of research is QRS complex detection. Detecting correct QRS complex or R peak is important since it is used to measure several other ECG metrics. One of the robust methods for QRS detection is Zero Cross method. This method uses an addition of high-frequency signal and zero crossing count to detect QRS complex which has a low-frequency oscillation. This paper presents an application of QRS detection using Zero Cross algorithm in the Android-based system. The performance of the algorithm in the mobile environment is measured. The result shows that this method is suitable for real-time QRS detection in a mobile application.

Association between QRS duration and obstructive sleep apnea.

PubMed

Gupta, Shuchita; Cepeda-Valery, Beatriz; Romero-Corral, Abel; Shamsuzzaman, Abu; Somers, Virend K; Pressman, Gregg S

2012-12-15

Both obstructive sleep apnea (OSA) and prolonged QRS duration are associated with hypertension, heart failure, and sudden cardiac death. However, possible links between QRS duration and OSA have not been explored. Cross-sectional study of 221 patients who underwent polysomnography at our center. Demographics, cardiovascular risk factors and ECG were collected to explore a relationship between OSA and QRS duration. The apnea-hypopnea index (AHI) was positively correlated with QRS duration (r = 0.141, p = 0.03). Patients were divided into 3 groups: AHI < 5 (61), AHI 5-29 (104), and AHI > 30 (55). The mean QRS duration prolonged significantly as OSA worsened (AHI < 5, 85 ± 9.5; AHI 5-29, 89 ± 11.9; and AHI > 30, 95 ± 19.9 ms, p = 0.001). QRS ≥ 100 ms was present in 12.7% of patients with severe OSA compared with 0% in the rest of the sample (p < 0.0001). After adjustment for age, race, and cardiovascular risk factors, this association remained significant in women but not in men. QRS duration and OSA were significantly associated. Severity of OSA independently predicted prolonged QRS in women but not men. Nevertheless, prolongation of QRS duration in either sex may potentiate arrhythmic risks associated with OSA.

Comparison of the calculation QRS angle for bundle branch block detection

NASA Astrophysics Data System (ADS)

Goeirmanto, L.; Mengko, R.; Rajab, T. L.

2016-04-01

QRS angle represent condition of blood circulation in the heart. Normally QRS angle is between -30 until 90 degree. Left Axis Defiation (LAD) and Right Axis Defiation (RAD) are abnormality conditions that lead to Bundle Branch Block. QRS angle is calculated using common method from physicians and compared to mathematical method using difference amplitudos and difference areas. We analyzed the standard 12 lead electrocardiogram data from MITBIH physiobank database. All methods using lead I and lead avF produce similar QRS angle and right QRS axis quadrant. QRS angle from mathematical method using difference areas is close to common method from physician. Mathematical method using difference areas can be used as a trigger for detecting heart condition.

[A research on real-time ventricular QRS classification methods for single-chip-microcomputers].

PubMed

Peng, L; Yang, Z; Li, L; Chen, H; Chen, E; Lin, J

1997-05-01

Ventricular QRS classification is key technique of ventricular arrhythmias detection in single-chip-microcomputer based dynamic electrocardiogram real-time analyser. This paper adopts morphological feature vector including QRS amplitude, interval information to reveal QRS morphology. After studying the distribution of QRS morphology feature vector of MIT/BIH DB ventricular arrhythmia files, we use morphological feature vector cluster to classify multi-morphology QRS. Based on the method, morphological feature parameters changing method which is suitable to catch occasional ventricular arrhythmias is presented. Clinical experiments verify missed ventricular arrhythmia is less than 1% by this method.

A new method for QRS detection in ECG signals using QRS-preserving filtering techniques.

PubMed

Sharma, Tanushree; Sharma, Kamalesh K

2018-03-28

Detection of QRS complexes in ECG signals is required for various purposes such as determination of heart rate, feature extraction and classification. The problem of automatic QRS detection in ECG signals is complicated by the presence of noise spectrally overlapping with the QRS frequency range. As a solution to this problem, we propose the use of least-squares-optimisation-based smoothing techniques that suppress the noise peaks in the ECG while preserving the QRS complexes. We also propose a novel nonlinear transformation technique that is applied after the smoothing operations, which equalises the QRS amplitudes without boosting the supressed noise peaks. After these preprocessing operations, the R-peaks can finally be detected with high accuracy. The proposed technique has a low computational load and, therefore, it can be used for real-time QRS detection in a wearable device such as a Holter monitor or for fast offline QRS detection. The offline and real-time versions of the proposed technique have been evaluated on the standard MIT-BIH database. The offline implementation is found to perform better than state-of-the-art techniques based on wavelet transforms, empirical mode decomposition, etc. and the real-time implementation also shows improved performance over existing real-time QRS detection techniques.

High frequency QRS ECG predicts ischemic defects during myocardial perfusion imaging

NASA Technical Reports Server (NTRS)

2004-01-01

Changes in high frequency QRS components of the electrocardiogram (HF QRS ECG) (150-250 Hz) are more sensitive than changes in conventional ST segments for detecting myocardial ischemia. We investigated the accuracy of 12-lead HF QRS ECG in detecting ischemia during adenosine tetrofosmin myocardial perfusion imaging (MPI). 12-lead HF QRS ECG recordings were obtained from 45 patients before and during adenosine technetium-99 tetrofosmin MPI tests. Before the adenosine infusions, recordings of HF QRS were analyzed according to a morphological score that incorporated the number, type and location of reduced amplitude zones (RAZs) present in the 12 leads. During the adenosine infusions, recordings of HF QRS were analyzed according to the maximum percentage changes (in both the positive and negative directions) that occurred in root mean square (RMS) voltage amplitudes within the 12 leads. The best set of prospective HF QRS criteria had a sensitivity of 94% and a specificity of 83% for correctly identifying the MPI result. The sensitivity of simultaneous ST segment changes (18%) was significantly lower than that of any individual HF QRS criterion (P less than 0.00l). Analysis of 12-lead HF QRS ECG is highly sensitive and specific for detecting ischemic perfusion defects during adenosine MPI stress tests and significantly more sensitive than analysis of conventional ST segments.

High frequency QRS ECG predicts ischemic defects during myocardial perfusion imaging

NASA Technical Reports Server (NTRS)

Rahman, Atiar

2006-01-01

Background: Changes in high frequency QRS components of the electrocardiogram (HF QRS ECG) (150-250 Hz) are more sensitive than changes in conventional ST segments for detecting myocardial ischemia. We investigated the accuracy of 12-lead HF QRS ECG in detecting ischemia during adenosine tetrofosmin myocardial perfusion imaging (MPI). Methods and Results: 12-lead HF QRS ECG recordings were obtained from 45 patients before and during adenosine technetium-99 tetrofosmin MPI tests. Before the adenosine infusions, recordings of HF QRS were analyzed according to a morphological score that incorporated the number, type and location of reduced amplitude zones (RAZs) present in the 12 leads. During the adenosine infusions, recordings of HF QRS were analyzed according to the maximum percentage changes (in both the positive and negative directions) that occurred in root mean square (RMS) voltage amplitudes within the 12 leads. The best set of prospective HF QRS criteria had a sensitivity of 94% and a specificity of 83% for correctly identifying the MPI result. The sensitivity of simultaneous ST segment changes (18%) was significantly lower than that of any individual HF QRS criterion (P<0.001). Conclusions: Analysis of 12-lead HF QRS ECG is highly sensitive and specific for detecting ischemic perfusion defects during adenosine MPI stress tests and significantly more sensitive than analysis of conventional ST segments.

Association between QRS Duration and Obstructive Sleep Apnea

PubMed Central

Gupta, Shuchita; Cepeda-Valery, Beatriz; Romero-Corral, Abel; Shamsuzzaman, Abu; Somers, Virend K.; Pressman, Gregg S.

2012-01-01

Background: Both obstructive sleep apnea (OSA) and prolonged QRS duration are associated with hypertension, heart failure, and sudden cardiac death. However, possible links between QRS duration and OSA have not been explored. Methods: Cross-sectional study of 221 patients who underwent polysomnography at our center. Demographics, cardiovascular risk factors and ECG were collected to explore a relationship between OSA and QRS duration. Results: The apnea-hypopnea index (AHI) was positively correlated with QRS duration (r = 0.141, p = 0.03). Patients were divided into 3 groups: AHI < 5 (61), AHI 5-29 (104), and AHI > 30 (55). The mean QRS duration prolonged significantly as OSA worsened (AHI < 5, 85 ± 9.5; AHI 5-29, 89 ± 11.9; and AHI > 30, 95 ± 19.9 ms, p = 0.001). QRS ≥ 100 ms was present in 12.7% of patients with severe OSA compared with 0% in the rest of the sample (p < 0.0001). After adjustment for age, race, and cardiovascular risk factors, this association remained significant in women but not in men. Conclusion: QRS duration and OSA were significantly associated. Severity of OSA independently predicted prolonged QRS in women but not men. Nevertheless, prolongation of QRS duration in either sex may potentiate arrhythmic risks associated with OSA. Citation: Gupta S; Cepeda-Valery B; Romero-Corral A; Shamsuzzaman A; Somers VK; Pressman GS. Association between QRS duration and obstructive sleep apnea. J Clin Sleep Med 2012;8(6):649-654. PMID:23243398

QRS analysis using wavelet transformation for the prediction of response to cardiac resynchronization therapy: a prospective pilot study.

PubMed

Vassilikos, Vassilios P; Mantziari, Lilian; Dakos, Georgios; Kamperidis, Vasileios; Chouvarda, Ioanna; Chatzizisis, Yiannis S; Kalpidis, Panagiotis; Theofilogiannakos, Efstratios; Paraskevaidis, Stelios; Karvounis, Haralambos; Mochlas, Sotirios; Maglaveras, Nikolaos; Styliadis, Ioannis H

2014-01-01

Wider QRS and left bundle branch block morphology are related to response to cardiac resynchronization therapy (CRT). A novel time-frequency analysis of the QRS complex may provide additional information in predicting response to CRT. Signal-averaged electrocardiograms were prospectively recorded, before CRT, in orthogonal leads and QRS decomposition in three frequency bands was performed using the Morlet wavelet transformation. Thirty eight patients (age 65±10years, 31 males) were studied. CRT responders (n=28) had wider baseline QRS compared to non-responders and lower QRS energies in all frequency bands. The combination of QRS duration and mean energy in the high frequency band had the best predicting ability (AUC 0.833, 95%CI 0.705-0.962, p=0.002) followed by the maximum energy in the high frequency band (AUC 0.811, 95%CI 0.663-0.960, p=0.004). Wavelet transformation of the QRS complex is useful in predicting response to CRT. © 2013.

Response of the ECG to short-term diuresis in patients with heart failure.

PubMed

Madias, John E; Song, Jessica; White, C Michael; Kalus, James S; Kluger, Jeffrey

2005-07-01

Increase in the amplitude of electrocardiogram (ECG) QRS complexes has been observed in patients treated for heart failure (HF), but the underlying mechanism has not been delineated. Also, correlation of augmentation of the QRS potentials with loss of weight has been noted in patients recovering from anasarca of varying etiology, or after hemodialysis. We assessed the effect of diuresis-based fluid loss in patients treated for HF on the amplitude of ECG QRS complexes. This is a cohort study based on ECG and other data from a previously published investigation of patients with HF conducted at a university affiliated hospital, which used new measurements and analysis, performed by a totally blinded investigator based at another institution. Twenty-one patients (10 men) aged 70.5+/-12.7 years, 13 with ischemic, and 8 with nonischemic cardiomyopathy, were admitted to the hospital for management of exacerbated HF and were observed for 48 hours. The patients received diuresis, and had routine laboratory testing, documentation of the net fluid lost, and recording of ECGs prior to the initiation of therapy and at 24 and 48 hours. Percent change (%Delta) over the course of observation in the sums of the amplitude of QRS complexes from 12 leads (SigmaQRS12), 6-limb leads (SigmaQRS6), and leads 1+2 (SigmaQRS2) in mm of standard ECGs were correlated with net fluid loss corrected for admission weight in mL/kg. Fluid loss amounted to 3204.9+/-1399.5 mL in the course of 40+/-23 hours of diuresis. SigmaQRS12 was 160.9+/-42.3 mm before and 170.0+/-50.7 mm after diuresis (P=0. 024). Percent change in SigmaQRS12, SigmaQRS6, and SigmaQRS2 correlated well with the net fluid loss (r=-0.70, -0.82, -0.61, and P=0.002, 0.0005, 0.001) correspondingly. Changes in sums of the amplitude of QRS complexes of the standard ECG correlates well with net fluid loss in response to short-term diuresis in patients with HF. Change in the SigmaQRS12, SigmaQRS6, and SigmaQRS2 from ECGs before and after diuresis can be used as an easily obtainable and universally available bedside index of the net fluid loss experienced by bedridden patients with HF undergoing therapy.

Composition and conductance distributions of single GeSi quantum rings studied by conductive atomic force microscopy combined with selective chemical etching.

PubMed

Lv, Y; Cui, J; Jiang, Z M; Yang, X J

2013-02-15

Atomic force microscopy imaging combined with selective chemical etching is employed to quantitatively investigate three-dimensional (3D) composition distributions of single GeSi quantum rings (QRs). In addition, the 3D quantitative composition distributions and the corresponding conductance distributions are simultaneously obtained on the same single GeSi QRs by conductive atomic force microscopy combined with selective chemical etching, allowing us to investigate the correlations between the conductance and composition distributions of single QRs. The results show that the QRs' central holes have higher Ge content, but exhibit lower conductance, indicating that the QRs' conductance distribution is not consistent with their composition distribution. By comparing the topography, composition and conductance profiles of the same single QRs before and after different etching processes, it is found that the conductance distributions of GeSi QRs do not vary with the change of composition distribution. Instead, the QRs' conductance distributions are found to be consistent with their topographic shapes, which can be supposed to be due to the shape determined electronic structures.

When Deriving the Spatial QRS-T Angle from the 12-lead ECG, which Transform is More Frank: Regression or Inverse Dower?

NASA Technical Reports Server (NTRS)

Schlegel, Todd T.; Cortez, Daniel

2010-01-01

Our primary objective was to ascertain which commonly used 12-to-Frank-lead transformation yields spatial QRS-T angle values closest to those obtained from simultaneously collected true Frank-lead recordings. Simultaneous 12-lead and Frank XYZ-lead recordings were analyzed for 100 post-myocardial infarction patients and 50 controls. Relative agreement, with true Frank-lead results, of 12-to-Frank-lead transformed results for the spatial QRS-T angle using Kors regression versus inverse Dower was assessed via ANOVA, Lin s concordance and Bland-Altman plots. Spatial QRS-T angles from the true Frank leads were not significantly different than those derived from the Kors regression-related transformation but were significantly smaller than those derived from the inverse Dower-related transformation (P less than 0.001). Independent of method, spatial mean QRS-T angles were also always significantly larger than spatial maximum (peaks) QRS-T angles. Spatial QRS-T angles are best approximated by regression-related transforms. Spatial mean and spatial peaks QRS-T angles should also not be used interchangeably.

Electrocardiographic parameters predict super-response in cardiac resynchronization therapy.

PubMed

Cvijić, Marta; Žižek, David; Antolič, Bor; Zupan, Igor

2015-01-01

Cardiac resynchronization therapy (CRT) is an established treatment for heart failure patients. However, determinants of response to CRT remain elusive. The aim of the study was to assess the value of ECG parameters to predict super-response in CRT patients. A 12-lead surface ECG was recorded at baseline and immediately after CRT-device implantation. Baseline ECG parameters (QRS duration, bundle branch morphology, axis, PR interval, QTc, intrinsicoid deflection) and post-implant paced QRS duration were analyzed; relative change in QRS duration was calculated. Decrease of left ventricular end-systolic volume ≥30% after 12 months was classified as super-response. In group of 101 patients, 32 (31.7%) were super-responders. There were no significant differences in baseline ECG parameters between super-responders and other patients. Post-implant QRS duration was shorter in super-responders (148 ± 22 ms vs. 162 ± 28 ms; P=0.010). Only in super-responders was significant QRS reduction observed after implantation. Relative QRS shortening was higher in super-responders (12.1% (6.8 to 22.2) vs. 1.7% (-11.9 to 11.8); P=0.005). In a multivariable analysis post-implant QRS duration and relative QRS shortening remained independent predictor of super-response. Absolute post-implant QRS duration and relative QRS shortening are the only ECG parameters associated with super-response in CRT. Further prospective studies on larger population are warranted to determine our findings. Copyright © 2015 Elsevier Inc. All rights reserved.

Association of QRS duration and survival in dogs with dilated cardiomyopathy: a retrospective study of 266 clinical cases.

PubMed

Pedro, Brigite M; Alves, Joana V; Cripps, Peter J; Stafford Johnson, Mike J; Martin, Mike W S

2011-12-01

The purpose of this study was to investigate the prognostic value of QRS duration in dogs with dilated cardiomyopathy (DCM) by studying its relationship with survival time. The medical records of dogs diagnosed with DCM were retrospectively searched for good quality ECG tracings. The QRS duration was measured from the ECG tracing and two different models were used: binary variable (dogs were divided into 2 groups based on a QRS duration of <60 ms or ≥60 ms) and continuous variable. The survival times were analysed by the Kaplan-Meier method and Cox's proportional hazard model. 266 dogs met the inclusion and exclusion criteria. A QRS duration ≥60 ms was associated with a reduced survival time compared to those with a QRS duration <60 ms (Hazard Ratio of 1.34, 95% CI 1.05-1.71, P = 0.02). When considered as a continuous variable the Hazard Ratio was 1.015 for each increase in QRS duration of 1 ms (95% CI 1.006-1.024, p = 0.001).Dogs with a QRS duration < 60 ms had a median survival time (IQ range) of 25 weeks (97-65) and dogs with a QRS duration ≥60 ms had a median survival time (IQ range) of 13 weeks (3-34). The measurement of QRS duration is relatively simple to perform from a surface ECG recording. A duration ≥60 ms is associated with shorter survival times in dogs with DCM, which may provide practitioners with additional prognostic information. Copyright © 2011 Elsevier B.V. All rights reserved.

Potential role of biventricular pacing beyond advanced systolic heart failure.

PubMed

Fang, Fang; Sanderson, John E; Yu, Cheuk-Man

2013-01-01

Cardiac resynchronization therapy (CRT) is an effective therapy for advanced heart failure (HF) patients. The indications are well defined in recent guidelines and broadly indicate that CRT is suitable for chronic HF patients with left ventricular ejection fraction (EF) ≤35% and in NYHA class III or IV (Class I), and those with prolonged QRS duration ≥120 ms with left bundle branch block (LBBB) QRS morphology, or QRS duration ≥150 ms irrespective of QRS morphology (Class IIa). For patients with NYHA class II symptoms, CRT is recommended for patients with EF ≤30% and QRS duration ≥130 ms with LBBB QRS morphology (Class I, level of evidence: A), or QRS duration ≥150 ms irrespective of QRS morphology (Class IIa, level of evidence: A). However, CRT may benefit additional patients outside these criteria. In this review, we summarize the role of CRT in some subgroups, including patients with mild and moderate HF, upgrading to CRT from right ventricular (RV) pacing, bradycardia patients with routine pacing indications, congenital heart disease and specific cardiomyopathies. It is possible that CRT can give symptomatic and mortality benefits in some of these subgroups in the future and further clinical trials are warranted.  

Diffuse Myocardial Fibrosis Reduces Electrocardiographic Voltage Measures of Left Ventricular Hypertrophy Independent of Left Ventricular Mass.

PubMed

Maanja, Maren; Wieslander, Björn; Schlegel, Todd T; Bacharova, Ljuba; Abu Daya, Hussein; Fridman, Yaron; Wong, Timothy C; Schelbert, Erik B; Ugander, Martin

2017-01-22

Myocardial fibrosis quantified by myocardial extracellular volume fraction (ECV) and left ventricular mass (LVM) index (LVMI) measured by cardiovascular magnetic resonance might represent independent and opposing contributors to ECG voltage measures of left ventricular hypertrophy (LVH). Diffuse myocardial fibrosis can occur in LVH and interfere with ECG voltage measures. This phenomenon could explain the decreased sensitivity of LVH detectable by ECG, a fundamental diagnostic tool in cardiology. We identified 77 patients (median age, 53 [interquartile range, 26-60] years; 49% female) referred for contrast-enhanced cardiovascular magnetic resonance with ECV measures and 12-lead ECG. Exclusion criteria included clinical confounders that might influence ECG measures of LVH. We evaluated ECG voltage-based LVH measures, including Sokolow-Lyon index, Cornell voltage, 12-lead voltage, and the vectorcardiogram spatial QRS voltage, with respect to LVMI and ECV. ECV and LVMI were not correlated (R 2 =0.02; P=0.25). For all voltage-related parameters, higher LVMI resulted in greater voltage (r=0.33-0.49; P<0.05 for all), whereas increased ECV resulted in lower voltage (r=-0.32 to -0.57; P<0.05 for all). When accounting for body fat, LV end-diastolic volume, and mass-to-volume ratio, both LVMI (β=0.58, P=0.03) and ECV (β=-0.46, P<0.001) were independent predictors of QRS voltage (multivariate adjusted R 2 =0.39; P<0.001). Myocardial mass and diffuse myocardial fibrosis have independent and opposing effects upon ECG voltage measures of LVH. Diffuse myocardial fibrosis quantified by ECV can obscure the ECG manifestations of increased LVM. This provides mechanistic insight, which can explain the limited sensitivity of the ECG for detecting increased LVM. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Detecting drug-induced prolongation of the QRS complex: New insights for cardiac safety assessment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cros, C., E-mail: caroline.cros@hotmail.co.uk; Skinner, M., E-mail: Matthew.Skinner@astrazeneca.com; Moors, J.

Background: Drugs slowing the conduction of the cardiac action potential and prolonging QRS complex duration by blocking the sodium current (I{sub Na}) may carry pro-arrhythmic risks. Due to the frequency-dependent block of I{sub Na}, this study assesses whether activity-related spontaneous increases in heart rate (HR) occurring during standard dog telemetry studies can be used to optimise the detection of class I antiarrhythmic-induced QRS prolongation. Methods: Telemetered dogs were orally dosed with quinidine (class Ia), mexiletine (class Ib) or flecainide (class Ic). QRS duration was determined standardly (5 beats averaged at rest) but also prior to and at the plateau ofmore » each acute increase in HR (3 beats averaged at steady state), and averaged over 1 h period from 1 h pre-dose to 5 h post-dose. Results: Compared to time-matched vehicle, at rest, only quinidine and flecainide induced increases in QRS duration (E{sub max} 13% and 20% respectively, P < 0.01–0.001) whereas mexiletine had no effect. Importantly, the increase in QRS duration was enhanced at peak HR with an additional effect of + 0.7 ± 0.5 ms (quinidine, NS), + 1.8 ± 0.8 ms (mexiletine, P < 0.05) and + 2.8 ± 0.8 ms (flecainide, P < 0.01) (calculated as QRS at basal HR-QRS at high HR). Conclusion: Electrocardiogram recordings during elevated HR, not considered during routine analysis optimised for detecting QT prolongation, can be used to sensitise the detection of QRS prolongation. This could prove useful when borderline QRS effects are detected. Analysing during acute increases in HR could also be useful for detecting drug-induced effects on other aspects of cardiac function. -- Highlights: ► We aimed to improve detection of drug-induced QRS prolongation in safety screening. ► We used telemetered dogs to test class I antiarrhythmics at low and high heart rate. ► At low heart rate only quinidine and flecainide induced an increase in QRS duration. ► At high heart rate the effects of two out of three antiarrhythmics were enhanced. ► Detection of a drug-induced prolongation of QRS was improved at high heart rate.« less

Association of intraventricular mechanical dyssynchrony with response to cardiac resynchronization therapy in heart failure patients with a narrow QRS complex

PubMed Central

van Bommel, Rutger J.; Tanaka, Hidekazu; Delgado, Victoria; Bertini, Matteo; Borleffs, Carel Jan Willem; Ajmone Marsan, Nina; Holzmeister, Johannes; Ruschitzka, Frank; Schalij, Martin J.; Bax, Jeroen J.; Gorcsan, John

2010-01-01

Aims Current criteria for cardiac resynchronization therapy (CRT) are restricted to patients with a wide QRS complex (>120 ms). Overall, only 30% of heart failure patients demonstrate a wide QRS complex, leaving the majority of heart failure patients without this treatment option. However, patients with a narrow QRS complex exhibit left ventricular (LV) mechanical dyssynchrony, as assessed with echocardiography. To further elucidate the possible beneficial effect of CRT in heart failure patients with a narrow QRS complex, this two-centre, non-randomized observational study focused on different echocardiographic parameters of LV mechanical dyssynchrony reflecting atrioventricular, interventricular and intraventricular dyssynchrony, and the response to CRT in these patients. Methods and results A total of 123 consecutive heart failure patients with a narrow QRS complex (<120 ms) undergoing CRT was included at two centres. Several widely accepted measures of mechanical dyssynchrony were evaluated: LV filling ratio (LVFT/RR), LV pre-ejection time (LPEI), interventricular mechanical dyssynchrony (IVMD), opposing wall delay (OWD), and anteroseptal posterior wall delay with speckle tracking (ASPWD). Response to CRT was defined as a reduction ≥15% in left ventricular end-systolic volume at 6 months follow-up. Measures of dyssynchrony can frequently be observed in patients with a narrow QRS complex. Nonetheless, for LVFT/RR, LPEI, and IVMD, presence of predefined significant dyssynchrony is <20%. Significant intraventricular dyssynchrony is more widely observed in these patients. With receiver operator characteristic curve analyses, both OWD and ASPWD demonstrated usefulness in predicting response to CRT in narrow QRS patients with a cut-off value of 75 and 107 ms, respectively. Conclusion Mechanical dyssynchrony can be widely observed in heart failure patients with a narrow QRS complex. In particular, intraventricular measures of mechanical dyssynchrony may be useful in predicting LV reverse remodelling at 6 months follow-up in heart failure patients with a narrow QRS complex, but with more stringent cut-off values than currently used in ‘wide’ QRS patients. PMID:20864484

Systolic blood pressure but not electrocardiogram QRS duration is associated with heart rate variability (HRV): a cross-sectional study in rural Australian non-diabetics.

PubMed

Lee, Yvonne Yin Leng; Jelinek, Herbert F; McLachlan, Craig S

2017-01-01

A positive correlation between ECG derived QRS duration and heart rate variability (HRV) parameters had previously been reported in young healthy adults. We note this study used a narrow QRS duration range, and did not adjust for systolic blood pressure. Our aims are to investigate associations between systolic blood pressure (SBP), QRS duration and HRV in a rural aging population. A retrospective cross sectional population was obtained from the CSU Diabetes Screening Research Initiative data base where 200 participants had no diabetes or pre-diabetes. SBP data were matched with ECG derived QRS duration and HRV parameters. HRV parameters were calculated from R-R intervals. Resting 12-lead electrocardiograms were obtained from each subject using a Welch Allyn PC-Based ECG system. Pearson correlation analysis revealed no statistically significant associations between HRV parameters and QRS duration. No significant mean differences in HRV parameter subgroups across defined QRS cut-offs were found. SBP > 146 mmHg was associated with increasing QRS durations, however this association disappeared once models were adjusted for age and gender. SBP was also significantly associated with a number of HRV parameters using Pearson correlation analysis, including high frequency (HF) ( p  < 0.05), HFln ( p  < 0.02), RMSDD ( p  < 0.02) and non-linear parameters; ApEN ( p  < 0.001) were negatively correlated with increasing SBP while the low frequency to high frequency ratio (LF/HF) increased with increasing SBP ( p  < 0.03). Our results do not support associations between ECG derived R-R derived HRV parameters and QRS duration in aging populations. We suggest that ventricular conduction as determined by QRS duration is independent of variations in SA-node heart rate variability.

Sodium channel blockade with QRS widening after an escitalopram overdose.

PubMed

Schreffler, Susan M; Marraffa, Jeanna M; Stork, Christine M; Mackey, Jennifer

2013-09-01

Escitalopram is rarely associated with prolongation of the QTc interval; however, there are no reported cases of QRS complex widening associated with escitalopram overdose. We report a case of a patient who presented with both QRS complex widening and QTc interval prolongation after an escitalopram overdose. A 16-year-old girl presented to the emergency department after ingestion of escitalopram, tramadol/acetaminophen, and hydrocodone/acetaminophen. Laboratory results were significant for 4-hour acetaminophen 21.1 μg/mL. Serum electrolytes including potassium, magnesium, and calcium were all normal. Initial electrocardiogram (ECG) revealed a widened QRS with an incomplete right bundle branch pattern. After administration of 100-mEq sodium bicarbonate, a repeat ECG revealed narrowing of the QRS complex and a prolonged QTc interval. Magnesium sulfate 2 g intravenous and sodium bicarbonate drip were initiated. A repeat ECG, 1 hour after the second, revealed normalization of the QRS complex and QTc interval. Prolongation of the QTc interval is an expected effect of escitalopram. Both escitalopram and citalopram are metabolized to the cardiotoxic metabolite S-didesmethylcitalopram and didesmethylcitalopram, respectively, which have been implicated in numerous cardiac abnormalities including widening of the QRS complex. Although never previously described with escitalopram, this mechanism provides a reasonable explanation for the QRS complex widening and incomplete right bundle branch block that occurred in our patient. Both QRS complex widening and QTc interval prolongation should be monitored in cases of escitalopram and citalopram overdoses.

The T/QRS ratio values in pregnancies complicated by threatened preterm labour treated with intravenous infusions of fenoterol.

PubMed

Fuchs, Tomasz; Pomorski, Michał; Grobelak, Krzysztof; Zimmer, Mariusz

2015-07-01

To evaluate values of foetal T/QRS ratios in pregnancies complicated by threatened preterm labour treated with intravenous infusions of fenoterol using non-invasive methods with transabdominal electrodes. The study group consisted of 451 Caucasian women (63 preterm pregnancies and 327 healthy controls) whose pregnancies ranged from 28 to 37 gestational weeks. Foetal electrocardiograms were recorded and T/QRS ratios were calculated by KOMPOREL software (ITAM, Zabrze, Poland). The first recording was performed 30 min after the start of fenoterol infusion and the second 2 days after finishing tocolysis. T/QRS ratio variables were calculated. One-way analysis of variance was carried out. Significantly higher mean values of the T/QRS ratio were observed in pregnancies during tocolytic treatment in comparison to controls and pregnancies after tocolysis (P=0.0158 and P=0.0071, respectively). The T/QRS ratio values fall again shortly after finishing intravenous tocolysis. The T/QRS ratio is one of the methods used for non-invasive foetal distress assessment that can be used in antepartum foetal monitoring in complicated pregnancies. Raised values of the T/QRS ratio in the foetus during tocolysis with fenoterol and next its fall to values observed in physiological pregnancies may indicate transient worsening of fetal well-being, however, additional research is required.

Biomarkers Investigation for In-Hospital Death in Patients With Stanford Type A Acute Aortic Dissection.

PubMed

Zhang, Ruoxi; Chen, Shuyuan; Zhang, Hui; Wang, Wei; Xing, Jianpang; Wang, Yu; Yu, Bo; Hou, Jingbo

2016-09-28

This retrospective study aimed to investigate the predictive value of biomarkers for in-hospital mortality of patients with Stanford type A acute aortic dissection (AAD).AAD is a life-threatening disease with an incidence of about 2.6-3.6 cases per 100,000/year.A total of 67 consecutive Stanford type A AAD patients admitted to hospital were divided into a deceased group and survival group. The baseline information of the patients between two groups was systematically compared, followed by examination of the electrocardiograms (ECG). Based on the follow-up during hospitalization, we investigated the simultaneous assessment of indexes like fragmented QRS complex (fQRS), admission systolic blood pressure (SBP), aortic diameter, surgical management, troponin I (TnI), white blood cell (WBC) count, N-terminal pro-brain natriuretic peptide (NT-proBNP), and D-dimer.The levels of TnI and NT-proBNP, WBC counts, and rate of fQRS (+) in patients of the deceased group were significantly higher than those in the survival group. The male sex (hazard ratio, 10.88; P = 0.001), admission SBP (hazard ratio, 0.98; P = 0.012), NT-proBNP (hazard ratio, 1.00; P = 0.001), and WBC count (hazard ratio, 1.10; P = 0.033) were independently related with in-hospital death. As a single marker, WBC count had the highest sensitivity at 84.6% (specificity 65.9%).Admission SBP, NT-proBNP, and WBC count were potential independent risk factors of in-hospital death in Stanford type A AAD patients. WBC count may be a more accurate predictor of type A AAD than either alone.

Nanoscale electrical property studies of individual GeSi quantum rings by conductive scanning probe microscopy.

PubMed

Lv, Yi; Cui, Jian; Jiang, Zuimin M; Yang, Xinju

2012-11-29

The nanoscale electrical properties of individual self-assembled GeSi quantum rings (QRs) were studied by scanning probe microscopy-based techniques. The surface potential distributions of individual GeSi QRs are obtained by scanning Kelvin microscopy (SKM). Ring-shaped work function distributions are observed, presenting that the QRs' rim has a larger work function than the QRs' central hole. By combining the SKM results with those obtained by conductive atomic force microscopy and scanning capacitance microscopy, the correlations between the surface potential, conductance, and carrier density distributions are revealed, and a possible interpretation for the QRs' conductance distributions is suggested.

Field programmable gate array based fuzzy neural signal processing system for differential diagnosis of QRS complex tachycardia and tachyarrhythmia in noisy ECG signals.

PubMed

Chowdhury, Shubhajit Roy

2012-04-01

The paper reports of a Field Programmable Gate Array (FPGA) based embedded system for detection of QRS complex in a noisy electrocardiogram (ECG) signal and thereafter differential diagnosis of tachycardia and tachyarrhythmia. The QRS complex has been detected after application of entropy measure of fuzziness to build a detection function of ECG signal, which has been previously filtered to remove power line interference and base line wander. Using the detected QRS complexes, differential diagnosis of tachycardia and tachyarrhythmia has been performed. The entire algorithm has been realized in hardware on an FPGA. Using the standard CSE ECG database, the algorithm performed highly effectively. The performance of the algorithm in respect of QRS detection with sensitivity (Se) of 99.74% and accuracy of 99.5% is achieved when tested using single channel ECG with entropy criteria. The performance of the QRS detection system has been compared and found to be better than most of the QRS detection systems available in literature. Using the system, 200 patients have been diagnosed with an accuracy of 98.5%.

Case report: an unstable wide QRS complexes tachycardia after ablation of a poster-septal accessory pathway: What is the mechanism?

PubMed

Wang, Huan; Che, Xiaoru

2018-03-01

Differentiation of wide QRS complex tachycardia required repeated electrophysiological stimuli and mapping. However, instability of tachycardia would increase the difficulty in differential diagnosis. In this paper, we reported a wide QRS tachycardia following ablation of an atrioventricular reentrant tachycardia participated by a poster-septal accessory pathway. Limited differentiation strategy was performed because the wide QRS tachycardia was self-limited and with unstable hemodynamics. We analyzed the mechanism of the wide QRS tachycardia by only 4 beats ventricular overpacing. On the basis of the last ventricular pacing, an atypical atrioventricular nodal reentrant tachycardia was confirmed. After slow-pathway modification, the wide QRS tachycardia was eliminated. It was an atypical atrial-ventricular node reentrant tachycardia with right bundle branch block. Reasonable analysis based on electrophysiological electrophysiologic knowledge was the basis of successful diagnosis and treatment.

Electrocardiogram changes and atrial arrhythmias in individuals carrying sodium channel SCN5A D1275N mutation.

PubMed

Vanninen, Sari U M; Nikus, Kjell; Aalto-Setälä, Katriina

2017-09-01

The cardiac sodium channel SCN5A regulates atrioventricular and ventricular depolarization as well as cardiac conduction. Patients with cardiac electrical abnormalities have an increased risk of sudden cardiac death (SCD) and cardio-embolic stroke. Optimal management of cardiac disease includes the understanding of association between the causative mutations and the clinical phenotype. A 12-lead electrocardiogram (ECG) is an easy and inexpensive tool for finding risk patients. A blood sample for DNA extraction was obtained in a Finnish family with 43 members; systematic 12-lead ECG analysis was performed in 13 of the family members carrying an SCN5A D1275N mutation. Conduction defects and supraventricular arrhythmias, including atrial fibrillation/flutter, atrioventricular nodal re-entry tachycardia (AVNRT) and junctional rhythm were searched for. Five (38%) mutation carriers had fascicular or bundle branch block, 10 had atrial arrhythmias; no ventricular arrhythmias were found. Notching of the R- and S waves - including initial QRS fragmentation - and prolonged S-wave upstroke were present in all the affected family members. Notably, four (31%) affected family members had a stroke before the age of 31 and two experienced premature death. A 12-lead ECG can be used to predict arrhythmias in SCN5A D1275N mutation carriers. Key messages The 12-lead ECG may reveal cardiac abnormalities even before clinical symptoms occur. Specific ECG findings - initial QRS fragmentation, prolonged S-wave upstroke as well as supraventricular arrhythmias - were frequently encountered in all SCN5A D1257N mutation carriers. ECG follow-up is recommended for all SCN5A D1275N mutation carriers.

High Frequency QRS ECG Accurately Detects Cardiomyopathy

NASA Technical Reports Server (NTRS)

Schlegel, Todd T.; Arenare, Brian; Poulin, Gregory; Moser, Daniel R.; Delgado, Reynolds

2005-01-01

High frequency (HF, 150-250 Hz) analysis over the entire QRS interval of the ECG is more sensitive than conventional ECG for detecting myocardial ischemia. However, the accuracy of HF QRS ECG for detecting cardiomyopathy is unknown. We obtained simultaneous resting conventional and HF QRS 12-lead ECGs in 66 patients with cardiomyopathy (EF = 23.2 plus or minus 6.l%, mean plus or minus SD) and in 66 age- and gender-matched healthy controls using PC-based ECG software recently developed at NASA. The single most accurate ECG parameter for detecting cardiomyopathy was an HF QRS morphological score that takes into consideration the total number and severity of reduced amplitude zones (RAZs) present plus the clustering of RAZs together in contiguous leads. This RAZ score had an area under the receiver operator curve (ROC) of 0.91, and was 88% sensitive, 82% specific and 85% accurate for identifying cardiomyopathy at optimum score cut-off of 140 points. Although conventional ECG parameters such as the QRS and QTc intervals were also significantly longer in patients than controls (P less than 0.001, BBBs excluded), these conventional parameters were less accurate (area under the ROC = 0.77 and 0.77, respectively) than HF QRS morphological parameters for identifying underlying cardiomyopathy. The total amplitude of the HF QRS complexes, as measured by summed root mean square voltages (RMSVs), also differed between patients and controls (33.8 plus or minus 11.5 vs. 41.5 plus or minus 13.6 mV, respectively, P less than 0.003), but this parameter was even less accurate in distinguishing the two groups (area under ROC = 0.67) than the HF QRS morphologic and conventional ECG parameters. Diagnostic accuracy was optimal (86%) when the RAZ score from the HF QRS ECG and the QTc interval from the conventional ECG were used simultaneously with cut-offs of greater than or equal to 40 points and greater than or equal to 445 ms, respectively. In conclusion 12-lead HF QRS ECG employing RAZ scoring is a simple, accurate and inexpensive screening technique for cardiomyopathy. Although HF QRS ECG is highly sensitive for cardiomyopathy, its specificity may be compromised in patients with cardiac pathologies other than cardiomyopathy, such as uncomplicated coronary artery disease or multiple coronary disease risk factors. Further studies are required to determine whether HF QRS might be useful for monitoring cardiomyopathy severity or the efficacy of therapy in a longitudinal fashion.

Automatic QRS complex detection using two-level convolutional neural network.

PubMed

Xiang, Yande; Lin, Zhitao; Meng, Jianyi

2018-01-29

The QRS complex is the most noticeable feature in the electrocardiogram (ECG) signal, therefore, its detection is critical for ECG signal analysis. The existing detection methods largely depend on hand-crafted manual features and parameters, which may introduce significant computational complexity, especially in the transform domains. In addition, fixed features and parameters are not suitable for detecting various kinds of QRS complexes under different circumstances. In this study, based on 1-D convolutional neural network (CNN), an accurate method for QRS complex detection is proposed. The CNN consists of object-level and part-level CNNs for extracting different grained ECG morphological features automatically. All the extracted morphological features are used by multi-layer perceptron (MLP) for QRS complex detection. Additionally, a simple ECG signal preprocessing technique which only contains difference operation in temporal domain is adopted. Based on the MIT-BIH arrhythmia (MIT-BIH-AR) database, the proposed detection method achieves overall sensitivity Sen = 99.77%, positive predictivity rate PPR = 99.91%, and detection error rate DER = 0.32%. In addition, the performance variation is performed according to different signal-to-noise ratio (SNR) values. An automatic QRS detection method using two-level 1-D CNN and simple signal preprocessing technique is proposed for QRS complex detection. Compared with the state-of-the-art QRS complex detection approaches, experimental results show that the proposed method acquires comparable accuracy.

Aiding the Detection of QRS Complex in ECG Signals by Detecting S Peaks Independently.

PubMed

Sabherwal, Pooja; Singh, Latika; Agrawal, Monika

2018-03-30

In this paper, a novel algorithm for the accurate detection of QRS complex by combining the independent detection of R and S peaks, using fusion algorithm is proposed. R peak detection has been extensively studied and is being used to detect the QRS complex. Whereas, S peaks, which is also part of QRS complex can be independently detected to aid the detection of QRS complex. In this paper, we suggest a method to first estimate S peak from raw ECG signal and then use them to aid the detection of QRS complex. The amplitude of S peak in ECG signal is relatively weak than corresponding R peak, which is traditionally used for the detection of QRS complex, therefore, an appropriate digital filter is designed to enhance the S peaks. These enhanced S peaks are then detected by adaptive thresholding. The algorithm is validated on all the signals of MIT-BIH arrhythmia database and noise stress database taken from physionet.org. The algorithm performs reasonably well even for the signals highly corrupted by noise. The algorithm performance is confirmed by sensitivity and positive predictivity of 99.99% and the detection accuracy of 99.98% for QRS complex detection. The number of false positives and false negatives resulted while analysis has been drastically reduced to 80 and 42 against the 98 and 84 the best results reported so far.

Fine-mapping, novel loci identification, and SNP association transferability in a genome-wide association study of QRS duration in African Americans.

PubMed

Evans, Daniel S; Avery, Christy L; Nalls, Mike A; Li, Guo; Barnard, John; Smith, Erin N; Tanaka, Toshiko; Butler, Anne M; Buxbaum, Sarah G; Alonso, Alvaro; Arking, Dan E; Berenson, Gerald S; Bis, Joshua C; Buyske, Steven; Carty, Cara L; Chen, Wei; Chung, Mina K; Cummings, Steven R; Deo, Rajat; Eaton, Charles B; Fox, Ervin R; Heckbert, Susan R; Heiss, Gerardo; Hindorff, Lucia A; Hsueh, Wen-Chi; Isaacs, Aaron; Jamshidi, Yalda; Kerr, Kathleen F; Liu, Felix; Liu, Yongmei; Lohman, Kurt K; Magnani, Jared W; Maher, Joseph F; Mehra, Reena; Meng, Yan A; Musani, Solomon K; Newton-Cheh, Christopher; North, Kari E; Psaty, Bruce M; Redline, Susan; Rotter, Jerome I; Schnabel, Renate B; Schork, Nicholas J; Shohet, Ralph V; Singleton, Andrew B; Smith, Jonathan D; Soliman, Elsayed Z; Srinivasan, Sathanur R; Taylor, Herman A; Van Wagoner, David R; Wilson, James G; Young, Taylor; Zhang, Zhu-Ming; Zonderman, Alan B; Evans, Michele K; Ferrucci, Luigi; Murray, Sarah S; Tranah, Gregory J; Whitsel, Eric A; Reiner, Alex P; Sotoodehnia, Nona

2016-10-01

The electrocardiographic QRS duration, a measure of ventricular depolarization and conduction, is associated with cardiovascular mortality. While single nucleotide polymorphisms (SNPs) associated with QRS duration have been identified at 22 loci in populations of European descent, the genetic architecture of QRS duration in non-European populations is largely unknown. We therefore performed a genome-wide association study (GWAS) meta-analysis of QRS duration in 13,031 African Americans from ten cohorts and a transethnic GWAS meta-analysis with additional results from populations of European descent. In the African American GWAS, a single genome-wide significant SNP association was identified (rs3922844, P = 4 × 10 -14 ) in intron 16 of SCN5A, a voltage-gated cardiac sodium channel gene. The QRS-prolonging rs3922844 C allele was also associated with decreased SCN5A RNA expression in human atrial tissue (P = 1.1 × 10 -4 ). High density genotyping revealed that the SCN5A association region in African Americans was confined to intron 16. Transethnic GWAS meta-analysis identified novel SNP associations on chromosome 18 in MYL12A (rs1662342, P = 4.9 × 10 -8 ) and chromosome 1 near CD1E and SPTA1 (rs7547997, P = 7.9 × 10 -9 ). The 22 QRS loci previously identified in populations of European descent were enriched for significant SNP associations with QRS duration in African Americans (P = 9.9 × 10 -7 ), and index SNP associations in or near SCN5A, SCN10A, CDKN1A, NFIA, HAND1, TBX5 and SETBP1 replicated in African Americans. In summary, rs3922844 was associated with QRS duration and SCN5A expression, two novel QRS loci were identified using transethnic meta-analysis, and a significant proportion of QRS-SNP associations discovered in populations of European descent were transferable to African Americans when adequate power was achieved. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

QRS duration predicts death and hospitalization among patients with atrial fibrillation irrespective of heart failure: evidence from the AFFIRM study

PubMed Central

Whitbeck, Matthew G.; Charnigo, Richard J.; Shah, Jignesh; Morales, Gustavo; Leung, Steve W.; Fornwalt, Brandon; Bailey, Alison L.; Ziada, Khaled; Sorrell, Vincent L.; Zegarra, Milagros M.; Thompson, Jenks; Hosn, Neil Aboul; Campbell, Charles L.; Gurley, John; Anaya, Paul; Booth, David C.; Biase, Luigi Di; Natale, Andrea; Smyth, Susan; Moliterno, David J.; Elayi, Claude S.

2014-01-01

Aims The association of QRS duration (QRSd) with morbidity and mortality is understudied in patients with atrial fibrillation (AF). We sought to assess any association of prolonged QRS with increased risk of death or hospitalization among patients with AF. Methods and results QRS duration was retrieved from the baseline electrocardiograms of patients enroled in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study and divided into three categories: <90, 90–119, ≥120 ms. Cox models were applied relating the hazards of mortality and hospitalizations to QRSd. Among 3804 patients with AF, 593 died and 2305 were hospitalized. Compared with those with QRS < 90 ms, patients with QRS ≥ 120 ms, had an increased mortality [hazard ratio (HR) 1.61, 95% confidence interval (CI): 1.29–2.03, P < 0.001] and hospitalizations (HR 1.14, 95% CI: 1.07–1.34, P = 0.043) over an average follow-up of 3.5 years. Importantly, for patients with QRS 90–119 ms, mortality and hospitalization were also increased (HR 1.31, P = 0.005 and 1.11, P = 0.026, respectively). In subgroup analysis based on heart failure (HF) status (previously documented or ejection fraction <40%), mortality was increased for QRS ≥ 120 ms patients with (HR 1.87, P < 0.001) and without HF (HR 1.63, P = 0.02). In the QRS 90–119 ms group, mortality was increased (HR 1.38, P = 0.03) for those with HF, but not significantly among those without HF (HR 1.23, P = 0.14). Conclusion Among patients with AF, QRSd ≥ 120 ms was associated with a substantially increased risk for mortality (all-cause, cardiovascular, and arrhythmic) and hospitalization. Interestingly, an increased mortality was also observed among those with QRS 90–119 ms and concomitant HF. PMID:24368753

Prolonged QRS duration on surface electrocardiogram is associated with left ventricular restrictive filling pattern.

PubMed

Erdoğan, Turan; Durakoğlugil, Murtaza Emre; Çiçek, Yüksel; Çetin, Mustafa; Duman, Hakan; Şatiroğlu, Ömer; Çelik, Şükrü

2017-03-01

Prolonged QRS duration is associated with decreased left ventricular (LV) systolic function. However, the relation between LV restrictive filling pattern (RFP) and QRS duration has not been investigated yet. The purpose of our study was to assess this relationship. We analyzed standard 12-lead surface electrocardiogram (ECG) of 155 consecutive patients. Mitral inflow and septal tissue velocities were obtained using the apical 4-chamber view with pulsed Doppler echocardiography. Patients were divided into 2 groups according to measured deceleration time (DT): restrictive (with DT ≤130 ms) or non-restrictive (with DT >130 ms). QRS duration was significantly longer in the restrictive group than in the non-restrictive group (0.101 vs. 0.090 s, p  < 0.0001). QRS duration of >0.10 s was highly specific (82.6%), but modestly sensitive (64.7%), for the prediction of LV RFP. Multivariate analyses demonstrated that E/A ratio, peak E, peak A, septal e', and a' velocities were significantly associated with RFP. Prolonged QRS duration (>0.10 s) obtained from a standard resting 12-lead ECG is associated with LV RFP. However, the relationship of QRS duration with RFP was not independent of echocardiographic parameters.

Aviation System Analysis Capability Quick Response System Report

NASA Technical Reports Server (NTRS)

Roberts, Eileen; Villani, James A.; Ritter, Paul

1998-01-01

The purpose of this document is to present the additions and modifications made to the Aviation System Analysis Capability (ASAC) Quick Response System (QRS) in FY 1997 in support of the ASAC ORS development effort. This document contains an overview of the project background and scope and defines the QRS. The document also presents an overview of the Logistics Management Institute (LMI) facility that supports the QRS, and it includes a summary of the planned additions to the QRS in FY 1998. The document has five appendices.

Algorithm for detection the QRS complexes based on support vector machine

NASA Astrophysics Data System (ADS)

Van, G. V.; Podmasteryev, K. V.

2017-11-01

The efficiency of computer ECG analysis depends on the accurate detection of QRS-complexes. This paper presents an algorithm for QRS complex detection based of support vector machine (SVM). The proposed algorithm is evaluated on annotated standard databases such as MIT-BIH Arrhythmia database. The QRS detector obtained a sensitivity Se = 98.32% and specificity Sp = 95.46% for MIT-BIH Arrhythmia database. This algorithm can be used as the basis for the software to diagnose electrical activity of the heart.

Distinctive Left Ventricular Activations Associated With ECG Pattern in Heart Failure Patients.

PubMed

Derval, Nicolas; Duchateau, Josselin; Mahida, Saagar; Eschalier, Romain; Sacher, Frederic; Lumens, Joost; Cochet, Hubert; Denis, Arnaud; Pillois, Xavier; Yamashita, Seigo; Komatsu, Yuki; Ploux, Sylvain; Amraoui, Sana; Zemmoura, Adlane; Ritter, Philippe; Hocini, Mélèze; Haissaguerre, Michel; Jaïs, Pierre; Bordachar, Pierre

2017-06-01

In contrast to patients with left bundle branch block (LBBB), heart failure patients with narrow QRS and nonspecific intraventricular conduction delay (NICD) display a relatively limited response to cardiac resynchronization therapy. We sought to compare left ventricular (LV) activation patterns in heart failure patients with narrow QRS and NICD to patients with LBBB using high-density electroanatomic activation maps. Fifty-two heart failure patients (narrow QRS [n=18], LBBB [n=11], NICD [n=23]) underwent 3-dimensional electroanatomic mapping with a high density of mapping points (387±349 LV). Adjunctive scar imaging was available in 37 (71%) patients and was analyzed in relation to activation maps. LBBB patients typically demonstrated (1) a single LV breakthrough at the septum (38±15 ms post-QRS onset); (2) prolonged right-to-left transseptal activation with absence of direct LV Purkinje activity; (3) homogeneous propagation within the LV cavity; and (4) latest activation at the basal lateral LV. In comparison, both NICD and narrow QRS patients demonstrated (1) multiple LV breakthroughs along the posterior or anterior fascicles: narrow QRS versus LBBB, 5±2 versus 1±1; P =0.0004; NICD versus LBBB, 4±2 versus 1±1; P =0.001); (2) evidence of early/pre-QRS LV electrograms with Purkinje potentials; (3) rapid propagation in narrow QRS patients and more heterogeneous propagation in NICD patients; and (4) presence of limited areas of late activation associated with LV scar with high interindividual heterogeneity. In contrast to LBBB patients, narrow QRS and NICD patients are characterized by distinct mechanisms of LV activation, which may predict poor response to cardiac resynchronization therapy. © 2017 American Heart Association, Inc.

Multipoint Pacing versus conventional ICD in Patients with a Narrow QRS complex (MPP Narrow QRS trial): study protocol for a pilot randomized controlled trial.

PubMed

Gasparini, Maurizio; Galimberti, Paola; Bragato, Renato; Ghio, Stefano; Raineri, Claudia; Landolina, Maurizio; Chieffo, Enrico; Lunati, Maurizio; Mulargia, Ederina; Proclemer, Alessandro; Facchin, Domenico; Rordorf, Roberto; Vicentini, Alessandro; Marcantoni, Lina; Zanon, Francesco; Klersy, Catherine

2016-12-03

Despite an intensive search for predictors of the response to cardiac resynchronization therapy (CRT), the QRS duration remains the simplest and most robust predictor of a positive response. QRS duration of ≥ 130 ms is considered to be a prerequisite for CRT; however, some studies have shown that CRT may also be effective in heart failure (HF) patients with a narrow QRS (<130 ms). Since CRT can now be performed by pacing the left ventricle from multiple vectors via a single quadripolar lead, it is possible that multipoint pacing (MPP) might be effective in HF patients with a narrow QRS. This article reports the design of the MPP Narrow QRS trial, a prospective, randomized, multicenter, controlled feasibility study to investigate the efficacy of MPP using two LV pacing vectors in patients with a narrow QRS complex (100-130 ms). Fifty patients with a standard ICD indication will be enrolled and randomized (1:1) to either an MPP group or a Standard ICD group. All patients will undergo a low-dose dobutamine stress echo test and only those with contractile reserve will be included in the study and randomized. The primary endpoint will be the percentage of patients in each group that have reverse remodeling at 12 months, defined as a reduction in left ventricular end-systolic volume (LVESV) of >15% from the baseline. This feasibility study will determine whether MPP improves reverse remodeling, as compared with standard ICD, in HF patients who have a narrow QRS complex (100-130 ms). ClinicalTrials.gov, NCT02402816 . Registered on 25 March 2015.

QRS Score at Presentation Electrocardiogram Is Correlated With Infarct Size and Mortality in ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention.

PubMed

Shiomi, Hiroki; Kosuge, Masami; Morimoto, Takeshi; Watanabe, Hiroki; Taniguchi, Tomohiko; Nakatsuma, Kenji; Toyota, Toshiaki; Yamamoto, Erika; Shizuta, Satoshi; Tada, Tomohisa; Furukawa, Yutaka; Nakagawa, Yoshihisa; Ando, Kenji; Kadota, Kazushige; Kimura, Kazuo; Kimura, Takeshi

2017-07-25

In ST-segment elevation myocardial infarction (STEMI), QRS score at presentation ECG may reflect the progression of infarction and facilitate prediction of the degree of myocardial salvage achieved by reperfusion therapy.Methods and Results:Admission electrocardiogram (ECG) was studied in 2,607 patients with STEMI undergoing primary percutaneous coronary intervention (PCI) within 24 h of symptom onset. Patients were classified into 3 groups according to QRS score: low (0-3, n=1,227), intermediate (4-7, n=810), and high (≥8, n=570). An increase of infarct size estimated by median peak creatine phosphokinase was observed as QRS score increased (low score, 1,836 IU/L; inter-quartile range (IQR), 979-3,190 IU/L; intermediate score, 2,488 IU/L; IQR, 1,126-4,640 IU/L; high score, 3,454 IU/L; IQR, 1,759-5,639 IU/L; P<0.001). Higher QRS score was associated with higher long-term mortality (low, intermediate, and high score, 15.6%, 19.7%, and 23.7% at 5 years, respectively; log-rank P<0.001). The positive relationship of QRS score with mortality was consistently seen when stratified by infarct location. The association of high QRS score with increased mortality was most remarkably seen in patients with early (≤2 h) presentation (low, intermediate, and high score: 16.7%, 16.6%, and 28.1% at 5 years, respectively; log-rank P<0.001). Higher QRS score at presentation ECG was associated with larger infarct size, and higher long-term mortality in patients with STEMI undergoing primary PCI. QRS score appears to be important in the early risk stratification for STEMI.

Prolonged QRS Widening After Aripiprazole Overdose.

PubMed

Mazer-Amirshahi, Maryann; Porter, Robert; Dewey, Kayla

2018-05-05

Aripiprazole is an atypical antipsychotic with a long half-life. Overdose can result in protracted somnolence and cardiac disturbances, particularly QT interval prolongation. This is a single case report of a 14-year-old boy who took an overdose of aripiprazole and developed QRS widening. A 14-year-old boy intentionally ingested 20 tablets of aripiprazole (5 mg). He was brought to the emergency department when his ingestion was discovered. The patient's vital signs were as follows: temperature, 37.7°C; heart rate, 108 beats/min; blood pressure, 138/98 mm Hg; and respirations, 16 breaths/min. Activated charcoal was administered within 90 minutes of ingestion. Initial electrocardiogram (EKG) showed sinus tachycardia, with a QRS of 138 ms and QT interval of 444 ms. QRS duration was 90 ms on an EKG performed 3 months earlier. A bolus of sodium bicarbonate was administered, and the patient was transferred to the pediatric intensive care unit. Repeat EKG demonstrated a QRS of 156 ms, and a sodium bicarbonate infusion was initiated. The patient continued to have QRS prolongation for the next 8 days, reaching a peak of 172 ms 3 days postingestion. Despite aggressive treatment with sodium bicarbonate, there was persistent QRS prolongation; however, the patient did not have any dysrhythmias and remained hemodynamically stable. The patient was discharged 9 days postingestion when the QRS duration normalized to 82 ms. Genetic testing revealed that the patient was a CYP2D6 poor metabolizer. This case suggests that aripiprazole toxicity may possibly be associated with QRS prolongation without associated dysrhythmias or cardiovascular compromise. In addition, toxicity may be prolonged in patients who are CYP2D6 poor metabolizers.

Reduced long-term overall mortality in heart failure patients with prolonged QRS treated with CRT combined with ICD vs. heart failure patients with narrow QRS treated with ICD only.

PubMed

Palmisano, Pietro; Accogli, Michele; Pisanò, Ennio Carmine Luigi; Zaccaria, Maria; De Blasi, Sergio; Ponzetta, Maria Antonietta; Valsecchi, Sergio; Milanese, Giovanni; Lauretti, Maurelio; Magliari, Francesco

2016-09-01

It is not known whether heart failure (HF) patients with prolonged QRS who undergo cardiac resynchronization therapy combined with a defibrillator (CRT-D) have a prognostic advantage over HF patients with narrow QRS (therefore without indication for CRT) treated with an implantable cardioverter defibrillator (ICD) only. The aim of this study was to compare the long-term mortality of a group of HF patients with prolonged QRS receiving CRT-D with that of a similar group of patients with narrow QRS receiving ICD only. A total of 312 patients (mean age 66 ± 13 years; 84% male, mean left ventricular ejection fraction 25 ± 4%, mean New York Heart Association class 2.6 ± 0.5) were included in the analysis. Of these, 138 with a QRS complex duration ≥120 ms received a CRT-D. During follow-up, the time and cause of death were assessed. During a median follow-up of 46 months, CRT-D patients showed significantly lower overall mortality (P = 0.038). Compared with patients receiving ICD only, CRT-D patients showed lower HF mortality (P = 0.003). Coronary mortality, non-cardiac mortality, and sudden mortality were similar in both groups (all P > 0.05). A positive response to CRT was an independent predictor of reduced mortality on multivariate analysis (hazard ratio: 0.27; P = 0.047). In HF patients treated with ICD, the subgroup of patients with prolonged QRS who receive CRT-D displays better long-term survival than narrow QRS ICD recipients, owing to their reduced HF mortality. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

Prolonged QRS duration on surface electrocardiogram is associated with left ventricular restrictive filling pattern

PubMed Central

Erdoğan, Turan; Durakoğlugil, Murtaza Emre; Çiçek, Yüksel; Çetin, Mustafa; Duman, Hakan; Şatiroğlu, Ömer; Çelik, Şükrü

2017-01-01

Background Prolonged QRS duration is associated with decreased left ventricular (LV) systolic function. However, the relation between LV restrictive filling pattern (RFP) and QRS duration has not been investigated yet. The purpose of our study was to assess this relationship. Methods We analyzed standard 12-lead surface electrocardiogram (ECG) of 155 consecutive patients. Mitral inflow and septal tissue velocities were obtained using the apical 4-chamber view with pulsed Doppler echocardiography. Patients were divided into 2 groups according to measured deceleration time (DT): restrictive (with DT ≤130 ms) or non-restrictive (with DT >130 ms). Results QRS duration was significantly longer in the restrictive group than in the non-restrictive group (0.101 vs. 0.090 s, p < 0.0001). QRS duration of >0.10 s was highly specific (82.6%), but modestly sensitive (64.7%), for the prediction of LV RFP. Multivariate analyses demonstrated that E/A ratio, peak E, peak A, septal e’, and a’ velocities were significantly associated with RFP. Conclusions Prolonged QRS duration (>0.10 s) obtained from a standard resting 12-lead ECG is associated with LV RFP. However, the relationship of QRS duration with RFP was not independent of echocardiographic parameters. PMID:28932490

Envelopment filter and K-means for the detection of QRS waveforms in electrocardiogram.

PubMed

Merino, Manuel; Gómez, Isabel María; Molina, Alberto J

2015-06-01

The electrocardiogram (ECG) is a well-established technique for determining the electrical activity of the heart and studying its diseases. One of the most common pieces of information that can be read from the ECG is the heart rate (HR) through the detection of its most prominent feature: the QRS complex. This paper describes an offline version and a real-time implementation of a new algorithm to determine QRS localization in the ECG signal based on its envelopment and K-means clustering algorithm. The envelopment is used to obtain a signal with only QRS complexes, deleting P, T, and U waves and baseline wander. Two moving average filters are applied to smooth data. The K-means algorithm classifies data into QRS and non-QRS. The technique is validated using 22 h of ECG data from five Physionet databases. These databases were arbitrarily selected to analyze different morphologies of QRS complexes: three stored data with cardiac pathologies, and two had data with normal heartbeats. The algorithm has a low computational load, with no decision thresholds. Furthermore, it does not require any additional parameter. Sensitivity, positive prediction and accuracy from results are over 99.7%. Copyright © 2015 IPEM. Published by Elsevier Ltd. All rights reserved.

QRS peak detection for heart rate monitoring on Android smartphone

NASA Astrophysics Data System (ADS)

Pambudi Utomo, Trio; Nuryani, Nuryani; Darmanto

2017-11-01

In this study, Android smartphone is used for heart rate monitoring and displaying electrocardiogram (ECG) graph. Heart rate determination is based on QRS peak detection. Two methods are studied to detect the QRS complex peak; they are Peak Threshold and Peak Filter. The acquisition of ECG data is utilized by AD8232 module from Analog Devices, three electrodes, and Microcontroller Arduino UNO R3. To record the ECG data from a patient, three electrodes are attached to particular body’s surface of a patient. Patient’s heart activity which is recorded by AD8232 module is decoded by Arduino UNO R3 into analog data. Then, the analog data is converted into a voltage value (mV) and is processed to get the QRS complex peak. Heart rate value is calculated by Microcontroller Arduino UNO R3 uses the QRS complex peak. Voltage, heart rate, and the QRS complex peak are sent to Android smartphone by Bluetooth HC-05. ECG data is displayed as the graph by Android smartphone. To evaluate the performance of QRS complex peak detection method, three parameters are used; they are positive predictive, accuracy and sensitivity. Positive predictive, accuracy, and sensitivity of Peak Threshold method is 92.39%, 70.30%, 74.62% and for Peak Filter method are 98.38%, 82.47%, 83.61%, respectively.

A QRS Detection and R Point Recognition Method for Wearable Single-Lead ECG Devices.

PubMed

Chen, Chieh-Li; Chuang, Chun-Te

2017-08-26

In the new-generation wearable Electrocardiogram (ECG) system, signal processing with low power consumption is required to transmit data when detecting dangerous rhythms and to record signals when detecting abnormal rhythms. The QRS complex is a combination of three of the graphic deflection seen on a typical ECG. This study proposes a real-time QRS detection and R point recognition method with low computational complexity while maintaining a high accuracy. The enhancement of QRS segments and restraining of P and T waves are carried out by the proposed ECG signal transformation, which also leads to the elimination of baseline wandering. In this study, the QRS fiducial point is determined based on the detected crests and troughs of the transformed signal. Subsequently, the R point can be recognized based on four QRS waveform templates and preliminary heart rhythm classification can be also achieved at the same time. The performance of the proposed approach is demonstrated using the benchmark of the MIT-BIH Arrhythmia Database, where the QRS detected sensitivity (Se) and positive prediction (+P) are 99.82% and 99.81%, respectively. The result reveals the approach's advantage of low computational complexity, as well as the feasibility of the real-time application on a mobile phone and an embedded system.

2D.03: IMPROVING DIAGNOSTIC STRATEGY IN PATIENTS WITH LONG-STANDING HYPERTENSION, CHEST PAIN AND NORMAL RESTING ECG: VALUE OF THE EXERCISE HIGH-FREQUENCY QRS VERSUS ST-SEGMENT ANALYSIS.

PubMed

Conti, A; Bianchi, S; Grifoni, C; Trausi, F; Angeli, E; Paolini, D; Catarzi, S; Perrotta, M E; Covelli, A; Renzi, N; Bertolini, P; Mazzucchelli, M

2015-06-01

The novel exercise computer-assisted high-frequency QRS-analysis (ex-HF/QRS) has demonstrated improved sensitivity and specificity over the conventional exercise-ST/ECG-segment-analysis (ex-ST/ECG) in the detection of myocardial ischemia. The aim of the present study was to test the implementation in diagnostic value of the ex-HF/QRS in patient with hypertension and chest pain (CP) versus the conventional ex-ST/ECG anlysis alone. Patients with long-standing hypertension, CP, normal ECG, troponin and echocardiography were enrolled. All patients underwent the ex-ST/ECG and ex-HF/QRS. A decrease >/=50% of the signal of ex-HF/QRS intensity recorded in two contiguous leads, at least, was considered as index of ischaemia, as ST-segment depression >/=2 mm or >/=1 mm and CP on ex-ST/ECG. Exclusion criteria were QRS duration >/=120 msec and inability to exercise. The end-point was the composite of coronary stenosis >50% or acute coronary syndrome, revascularization, cardiovascular death at 3-month follow-up. Six-hundred thirty-one patients were enrolled (age 61+/-15 y). The percentage of age-adjusted maximal predicted heart rate was 88+/-10 beat-per-minute and the maximal systolic blood pressure was 169+/-22 mmHg. Twenty-seven patients achieved the end-point. On multivariate analysis, both the ex-ST/ECG and ex-HF/QRS were predictors of the end-point. The ex-HF/QRS showed higher sensitivity (88% vs 50%; p = 0.003), lower specificity (77% vs 97%; p = 0.245) and comparable negative predictive value (99% vs 99%; p = NS) when compared to ex-ST/ECG. Receiver operator characteristics (ROC) analysis showed the incremental diagnostic value of the ex-HF/QRS (area: 0.64, 95% Confidence Intervals, CI 0.51-0.77) over conventional ex-ST/ECG (0.60, CI 0.52-0.66) and Chest Pain Score (0.53, CI 0.48-0.59); p = NS on pairwise C-statistic. In patients with long-standing hypertension and CP submitted to risk stratification with exercise tolerance test, the novel ex-HF/QRS shows a valuable incremental diagnostic value over ex-ST/ECG.

Echocardiographic evaluation of cardiac dyssynchrony in patients with congestive heart failure.

PubMed

Qin, Chuan; Zhang, Li; Zhang, Zi-Ming; Wang, Bin; Ye, Zhou; Wang, Yong; Nanda, Navin C; Xie, Ming-Xing

2016-06-01

The present study investigated the application of echocardiography to evaluation of cardiac dyssynchrony in patients with congestive heart failure (CHF). A total of 348 consecutive CHF patients who were admitted for cardiac resynchronization (CRT) and presented with low ejection fraction (EF) and wide QRS duration were enrolled in this study, along with 388 healthy individuals. Dyssynchrony was assessed based on filling time ratio (FT/RR), left ventricular pre-ejection delay (PED), interventricular mechanical delay (IVMD), longitudinal opposing wall delay (LOWD) and radial septal to posterior wall delay (RSPWD). Response to CRT was defined as a ≥15% increase in EF. The results showed that FT/RR was decreased while PED, IVMD, LOWD and RSPWD were increased in the CHF group compared with the control group (P<0.01). In the CHF group, FT/RR was negatively correlated with the QRS duration, LV end-diastolic diameter (LVESd), LV end-diastolic volume (LVEDV) and LV end-systolic volume (LVESV) (P<0.01), but positively with the LVEF (P<0.01). Additionally, PED, IVMD, LOWD and RSPWD were positively correlated with the QRS duration, LVESd, LVEDV and LVESV (P<0.01), but negatively with the LVEF (P<0.01). The CHF group was divided into three subgroups according to the varying degrees of LVEF. FT/RR decreased successively from the LVEF-1 group to the LVEF-2 group to the LVEF-3 group, while the PED, IVMD, LOWD and RSPWD successively increased in the same order (P<0.01). The CHF group was divided into three subgroups according to the varying degrees of QRS duration, and FT/RR decreased successively in a sequence from the QRS-1 group to the QRS-2 group to the QRS-3 group, while the PED, IVMD, LOWD and RSPWD successively increased in the same order (P<0.01). Speckle tracking radial dyssynchrony ≥130 ms was predictive of an EF response in patients in QRS-1 group (78% sensitivity, 83% specificity), those in QRS-2 group (83% sensitivity, 77% specificity) and in QRS-3 group (89% sensitivity, 79% specificity). In conclusion, echocardiography is a convenient and sensitive method for evaluating cardiac dyssynchrony in patients with CHF.

Fine-mapping, novel loci identification, and SNP association transferability in a genome-wide association study of QRS duration in African Americans

PubMed Central

Evans, Daniel S.; Avery, Christy L.; Nalls, Mike A.; Li, Guo; Barnard, John; Smith, Erin N.; Tanaka, Toshiko; Butler, Anne M.; Buxbaum, Sarah G.; Alonso, Alvaro; Arking, Dan E.; Berenson, Gerald S.; Bis, Joshua C.; Buyske, Steven; Carty, Cara L.; Chen, Wei; Chung, Mina K.; Cummings, Steven R.; Deo, Rajat; Eaton, Charles B.; Fox, Ervin R.; Heckbert, Susan R.; Heiss, Gerardo; Hindorff, Lucia A.; Hsueh, Wen-Chi; Isaacs, Aaron; Jamshidi, Yalda; Kerr, Kathleen F.; Liu, Felix; Liu, Yongmei; Lohman, Kurt K.; Magnani, Jared W.; Maher, Joseph F.; Mehra, Reena; Meng, Yan A.; Musani, Solomon K.; Newton-Cheh, Christopher; North, Kari E.; Psaty, Bruce M.; Redline, Susan; Rotter, Jerome I.; Schnabel, Renate B.; Schork, Nicholas J.; Shohet, Ralph V.; Singleton, Andrew B.; Smith, Jonathan D.; Soliman, Elsayed Z.; Srinivasan, Sathanur R.; Taylor, Herman A.; Van Wagoner, David R.; Wilson, James G.; Young, Taylor; Zhang, Zhu-Ming; Zonderman, Alan B.; Evans, Michele K.; Ferrucci, Luigi; Murray, Sarah S.; Tranah, Gregory J.; Whitsel, Eric A.; Reiner, Alex P.; Sotoodehnia, Nona

2016-01-01

The electrocardiographic QRS duration, a measure of ventricular depolarization and conduction, is associated with cardiovascular mortality. While single nucleotide polymorphisms (SNPs) associated with QRS duration have been identified at 22 loci in populations of European descent, the genetic architecture of QRS duration in non-European populations is largely unknown. We therefore performed a genome-wide association study (GWAS) meta-analysis of QRS duration in 13,031 African Americans from ten cohorts and a transethnic GWAS meta-analysis with additional results from populations of European descent. In the African American GWAS, a single genome-wide significant SNP association was identified (rs3922844, P = 4 × 10−14) in intron 16 of SCN5A, a voltage-gated cardiac sodium channel gene. The QRS-prolonging rs3922844 C allele was also associated with decreased SCN5A RNA expression in human atrial tissue (P = 1.1 × 10−4). High density genotyping revealed that the SCN5A association region in African Americans was confined to intron 16. Transethnic GWAS meta-analysis identified novel SNP associations on chromosome 18 in MYL12A (rs1662342, P = 4.9 × 10−8) and chromosome 1 near CD1E and SPTA1 (rs7547997, P = 7.9 × 10−9). The 22 QRS loci previously identified in populations of European descent were enriched for significant SNP associations with QRS duration in African Americans (P = 9.9 × 10−7), and index SNP associations in or near SCN5A, SCN10A, CDKN1A, NFIA, HAND1, TBX5 and SETBP1 replicated in African Americans. In summary, rs3922844 was associated with QRS duration and SCN5A expression, two novel QRS loci were identified using transethnic meta-analysis, and a significant proportion of QRS–SNP associations discovered in populations of European descent were transferable to African Americans when adequate power was achieved. PMID:27577874

Colorado Qualistar. QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Colorado's Qualistar prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators for Family…

Pennsylvania Keystone STARS: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Pennsylvania's Keystone STARS prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators for…

Virginia Star Quality Initiative: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Virginia's Star Quality Initiative prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators…

Illinois Quality Counts: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Illinois' Quality Counts prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators for Family…

Mississippi Quality Step System: QRS Profile. The Child Care Quality Rating System (QRS)Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Mississippi's Quality Step System prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Application…

Minnesota Parent Aware: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Minnesota's Parent Aware prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators for Family…

New micro waveforms firstly recorded on electrocardiogram in human.

PubMed

Liu, Renguang; Chang, Qinghua; Chen, Juan

2015-10-01

In our study, not only the P-QRS-T waves but also the micro-wavelets before QRS complex (in P wave and PR segment) and after QRS complex (ST segment and upstroke of T wave) were first to be identified on surface electrocardiogram in human by the "new electrocardiogram" machine (model PHS-A10) according to conventional 12-lead electrocardiogram connection methods. By comparison to the conventional electrocardiogram in 100 cases of healthy individuals and several patients with arrhythmias, we have found that the wavelets before P wave theoretically reflected electrical activity of sinus node and the micro-wavelets before QRS complex may be related to atrioventricular conduction system (atrioventricular node, His bundle and bundle branch) potentials. Noninvasive atrioventricular node and His bundle potential tracing will contribute to differentiation of the origin of wide QRS and the location of the atrioventricular block. We also have found that the wavelets after QRS complex may be associated with phase 2 and 3 repolarization of ventricular action potential, which will further reveal ventricular repolarization changes. Copyright © 2015 Elsevier Ltd. All rights reserved.

Spectral analysis of 87-lead body surface signal-averaged ECGs in patients with previous anterior myocardial infarction as a marker of ventricular tachycardia.

PubMed

Hosoya, Y; Kubota, I; Shibata, T; Yamaki, M; Ikeda, K; Tomoike, H

1992-06-01

There were few studies on the relation between the body surface distribution of high- and low-frequency components within the QRS complex and ventricular tachycardia (VT). Eighty-seven signal-averaged ECGs were obtained from 30 normal subjects (N group) and 30 patients with previous anterior myocardial infarction (MI) with VT (MI-VT[+] group, n = 10) or without VT (MI-VT[-] group, n = 20). The onset and offset of the QRS complex were determined from 87-lead root mean square values computed from the averaged (but not filtered) ECG waveforms. Fast Fourier transform analysis was performed on signal-averaged ECG. The resulting Fourier coefficients were attenuated by use of the transfer function, and then inverse transform was done with five frequency ranges (0-25, 25-40, 40-80, 80-150, and 150-250 Hz). From the QRS onset to the QRS offset, the time integration of the absolute value of reconstructed waveforms was calculated for each of the five frequency ranges. The body surface distributions of these areas were expressed as QRS area maps. The maximal values of QRS area maps were compared among the three groups. In the frequency ranges of 0-25 and 150-250 Hz, there were no significant differences in the maximal values among these three groups. Both MI groups had significantly smaller maximal values of QRS area maps in the frequency ranges of 25-40 and 40-80 Hz compared with the N group. The MI-VT(+) group had significantly smaller maximal values in the frequency ranges of 40-80 and 80-150 Hz than the MI-VT(-) group. These three groups were clearly differentiated by the maximal values of the 40-80-Hz QRS area map. It was suggested that the maximal value of the 40-80-Hz QRS area map was a new marker for VT after anterior MI.

QT Interval Prolongation and QRS Voltage Reduction in Patients with Liver Cirrhosis.

PubMed

Cichoż-Lach, Halina; Tomaszewski, Michał; Kowalik, Agnieszka; Lis, Emilia; Tomaszewski, Andrzej; Lach, Tomasz; Boczkowska, Sylwia; Celiński, Krzysztof

2015-01-01

Liver cirrhosis is associated with functional abnormalities of the cardiovascular system with co-existing electrocardiographic (ECG) abnormalities. The aim was to analyze ECG changes in patients with cirrhosis, to evaluate whether alcoholic etiology of cirrhosis and ascites has an impact on ECG changes. The study involved 81 patients with previously untreated alcoholic cirrhosis (64 patients with ascites, classes B and C according to the Child-Pugh classification; and 17 without ascites, categorized as class A); 41 patients with previously untreated cirrhosis due to chronic hepatitis C (HCV--30 patients with ascites, classes B and C; and 11 without ascites, class A); 42 with alcoholic steatohepatitis and 46 with alcoholic steatosis. The control group consisted of 32 healthy volunteers. Twelve-lead ECG recordings were performed and selected parameters were measured. Significantly longer QT and QTc intervals and lower QRS voltage were found in patients with alcoholic and HCV cirrhosis compared to the controls. Significantly lower QRS voltage was found in subjects with ascites than in those without ascites. Removal of ascites significantly increased QRS voltage. In cirrhosis, irrespective of etiology, ECG changes involved prolonged QT and QTc intervals and reduced QRS voltage. Prolonged QT and QTc intervals were not related to the severity of cirrhosis or to the presence of ascites. However, low QRS voltage was associated with the presence of ascites. Removal of ascites reverses low QRS voltage.

Delaware Stars for Early Success. QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Delaware's Stars for Early Success prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators…

Palm Beach Quality Counts: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Palm Beach's Quality Counts prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators for…

Tennessee Star-Quality Child Care Program: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Tennessee's Star-Quality Child Care Program prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4)…

Maine Quality for ME: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Maine's Quality for ME prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators for Family…

Vermont STep Ahead Recognition System: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Vermont's STep Ahead Recognition System (STARS) prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for All Child Care Programs;…

Missouri Quality Rating System: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Missouri's Quality Rating System prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators for…

Ohio Step Up to Quality: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Ohio's Step Up to Quality prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators for Family…

Miami-Dade Quality Counts: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Miami-Dade's Quality Counts prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators for…

Kentucky STARS for KIDS NOW: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Kentucky's STARS for KIDS NOW prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators for…

Indiana Paths to Quality: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Indiana's Paths to Quality prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators for…

North Carolina Star Rated License System: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of North Carolina's Star Rated License System prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4)…

Oregon Child Care Quality Indicators Program: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Oregon's Child Care Quality Indicators Program prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4)…

New Hampshire Quality Rating System: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of New Hampshire's Quality Rating System prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4)…

Value of the Qrs-T Angle in Predicting the Induction of Ventricular Tachyarrhythmias in Patients with Chagas Disease.

PubMed

Zampa, Hugo Bizetto; Moreira, Dalmo Ar; Ferreira Filho, Carlos Alberto Brandão; Souza, Charles Rios; Menezes, Camila Caldas; Hirata, Henrique Seichii; Armaganijan, Luciana Vidal

2014-10-28

Background: The QRS-T angle correlates with prognosis in patients with heart failure and coronary artery disease, reflected by an increase in mortality proportional to an increase in the difference between the axes of the QRS complex and T wave in the frontal plane. The value of this correlation in patients with Chagas heart disease is currently unknown. Objective: Determine the correlation of the QRS-T angle and the risk of induction of ventricular tachycardia / ventricular fibrillation (VT / VF) during electrophysiological study (EPS) in patients with Chagas disease. Methods: Case-control study at a tertiary center. Patients without induction of VT / VF on EPS were used as controls. The QRS-T angle was categorized as normal (0-105º), borderline (105-135º) or abnormal (135-180º). Differences between groups for continuous variables were analyzed with the t test or Mann-Whitney test, and for categorical variables with Fisher's exact test. P values < 0.05 were considered significant. Results: Of 116 patients undergoing EPS, 37.9% were excluded due to incomplete information / inactive records or due to the impossibility to correctly calculate the QRS-T angle (presence of left bundle branch block and atrial fibrillation). Of 72 patients included in the study, 31 induced VT / VF on EPS. Of these, the QRS-T angle was normal in 41.9%, borderline in 12.9% and abnormal in 45.2%. Among patients without induction of VT / VF on EPS, the QRS-T angle was normal in 63.4%, borderline in 14.6% and abnormal in 17.1% (p = 0.04). When compared with patients with normal QRS-T angle, those with abnormal angle had a fourfold higher risk of inducing ventricular tachycardia / ventricular fibrillation on EPS [odds ratio (OR) 4; confidence interval (CI) 1.298-12.325; p = 0.028]. After adjustment for other variables such as age, ejection fraction (EF) and QRS size, there was a trend for the abnormal QRS-T angle to identify patients with increased risk of inducing VT / VF during EPS (OR 3.95; CI 0.99-15.82; p = 0.052). The EF also emerged as a predictor of induction of VT / VF: for each point increase in EF, there was a 4% reduction in the rate of sustained ventricular arrhythmia on EPS. Conclusions: Changes in the QRS-T angle and decreases in EF were associated with an increased risk of induction of VT / VF on EPS.Fundamento: O ângulo QRS-T mostra correlação com prognóstico em pacientes com insuficiência cardíaca e doença coronariana, traduzido por um aumento na mortalidade proporcional ao aumento na diferença entre os eixos do complexo QRS e da onda T no plano frontal. Até hoje, nenhuma informação a este respeito foi obtida em pacientes com cardiopatia chagásica. Objetivo: Correlacionar o ângulo QRS-T com a indução de taquicardia ventricular / fibrilação ventricular (TV / FV) em chagásicos durante estudo eletrofisiológico (EEF). Métodos: Estudo caso-controle em centro terciário. Pacientes sem indução de TV / FV ao EEF foram utilizados como controles. O ângulo QRS-T foi categorizado como normal (0-105º), limítrofe (105-135º) e anormal (135-180º). As diferenças entre os grupos foram analisadas pelo teste t ou teste de Mann-Whitney para variáveis contínuas, e teste exato de Fisher ou qui-quadrado para variáveis categóricas. Valores de p < 0,05 foram considerados significativos. Resultados: De 116 pacientes submetidos ao EEF, 37,9% foram excluídos por estarem com dados incompletos / prontuários inativos ou pela impossibilidade de se calcular corretamente o ângulo QRS-T (presença de bloqueio de ramo esquerdo e fibrilação atrial). De 72 pacientes incluídos, 31 induziram TV / FV ao EEF. Destes, o ângulo QRS-T se encontrava normal em 41,9%, limítrofe em 12,9% e anormal em 45,2%. No grupo de pacientes sem indução de TV / FV, o ângulo QRS-T se encontrava normal em 63,4%, limítrofe em 14,6% e anormal em 17,1% (p = 0,04). Quando comparados aos pacientes com ângulo QRS-T normal, o risco de indução de TV / FV nos pacientes com ângulo anormal foi quatro vezes maior [odds ratio (OR) 4; intervalo de confiança (IC) 1,298-12,325; p = 0,028). Após ajuste para outras variáveis como idade, fração de ejeção (FE) e tamanho do QRS, houve tendência do ângulo QRS-T anormal em identificar pacientes com maior risco de indução de TV / FV (OR 3,95; IC 0,99-15,82; p = 0,052). A FE também se evidenciou como preditora de indução de TV / FV: um ponto de aumento na FE reduziu em 4% a taxa de indução de arritmia ventricular sustentada ao EEF. Conclusões: Alterações no ângulo QRS-T e redução na FE estiveram associadas a um aumento no risco de indução de TV / FV ao EEF.

The impact of trans-catheter aortic valve replacement induced left-bundle branch block on cardiac reverse remodeling.

PubMed

Dobson, Laura E; Musa, Tarique A; Uddin, Akhlaque; Fairbairn, Timothy A; Bebb, Owen J; Swoboda, Peter P; Haaf, Philip; Foley, James; Garg, Pankaj; Fent, Graham J; Malkin, Christopher J; Blackman, Daniel J; Plein, Sven; Greenwood, John P

2017-02-22

Left bundle branch block (LBBB) is common following trans-catheter aortic valve replacement (TAVR) and has been linked to increased mortality, although whether this is related to less favourable cardiac reverse remodeling is unclear. The aim of the study was to investigate the impact of TAVR induced LBBB on cardiac reverse remodeling. 48 patients undergoing TAVR for severe aortic stenosis were evaluated. 24 patients with new LBBB (LBBB-T) following TAVR were matched with 24 patients with a narrow post-procedure QRS (nQRS). Patients underwent cardiovascular magnetic resonance (CMR) prior to and 6 m post-TAVR. Measured cardiac reverse remodeling parameters included left ventricular (LV) size, ejection fraction (LVEF) and global longitudinal strain (GLS). Inter- and intra-ventricular dyssynchrony were determined using time to peak radial strain derived from CMR Feature Tracking. In the LBBB-T group there was an increase in QRS duration from 96 ± 14 to 151 ± 12 ms (P < 0.001) leading to inter- and intra-ventricular dyssynchrony (inter: LBBB-T 130 ± 73 vs nQRS 23 ± 86 ms, p < 0.001; intra: LBBB-T 118 ± 103 vs. nQRS 13 ± 106 ms, p = 0.001). Change in indexed LV end-systolic volume (LVESVi), LVEF and GLS was significantly different between the two groups (LVESVi: nQRS -7.9 ± 14.0 vs. LBBB-T -0.6 ± 10.2 ml/m 2 , p = 0.02, LVEF: nQRS +4.6 ± 7.8 vs LBBB-T -2.1 ± 6.9%, p = 0.002; GLS: nQRS -2.1 ± 3.6 vs. LBBB-T +0.2 ± 3.2%, p = 0.024). There was a significant correlation between change in QRS and change in LVEF (r = -0.434, p = 0.002) and between change in QRS and change in GLS (r = 0.462, p = 0.001). Post-procedure QRS duration was an independent predictor of change in LVEF and GLS at 6 months. TAVR-induced LBBB is associated with less favourable cardiac reverse remodeling at medium term follow up. In view of this, every effort should be made to prevent TAVR-induced LBBB, especially as TAVR is now being extended to a younger, lower risk population.

Robust QRS detection for HRV estimation from compressively sensed ECG measurements for remote health-monitoring systems.

PubMed

Pant, Jeevan K; Krishnan, Sridhar

2018-03-15

To present a new compressive sensing (CS)-based method for the acquisition of ECG signals and for robust estimation of heart-rate variability (HRV) parameters from compressively sensed measurements with high compression ratio. CS is used in the biosensor to compress the ECG signal. Estimation of the locations of QRS segments is carried out by applying two algorithms on the compressed measurements. The first algorithm reconstructs the ECG signal by enforcing a block-sparse structure on the first-order difference of the signal, so the transient QRS segments are significantly emphasized on the first-order difference of the signal. Multiple block-divisions of the signals are carried out with various block lengths, and multiple reconstructed signals are combined to enhance the robustness of the localization of the QRS segments. The second algorithm removes errors in the locations of QRS segments by applying low-pass filtering and morphological operations. The proposed CS-based method is found to be effective for the reconstruction of ECG signals by enforcing transient QRS structures on the first-order difference of the signal. It is demonstrated to be robust not only to high compression ratio but also to various artefacts present in ECG signals acquired by using on-body wireless sensors. HRV parameters computed by using the QRS locations estimated from the signals reconstructed with a compression ratio as high as 90% are comparable with that computed by using QRS locations estimated by using the Pan-Tompkins algorithm. The proposed method is useful for the realization of long-term HRV monitoring systems by using CS-based low-power wireless on-body biosensors.

An individual patient meta-analysis of five randomized trials assessing the effects of cardiac resynchronization therapy on morbidity and mortality in patients with symptomatic heart failure.

PubMed

Cleland, John G; Abraham, William T; Linde, Cecilia; Gold, Michael R; Young, James B; Claude Daubert, J; Sherfesee, Lou; Wells, George A; Tang, Anthony S L

2013-12-01

Cardiac resynchronization therapy (CRT) with or without a defibrillator reduces morbidity and mortality in selected patients with heart failure (HF) but response can be variable. We sought to identify pre-implantation variables that predict the response to CRT in a meta-analysis using individual patient-data. An individual patient meta-analysis of five randomized trials, funded by Medtronic, comparing CRT either with no active device or with a defibrillator was conducted, including the following baseline variables: age, sex, New York Heart Association class, aetiology, QRS morphology, QRS duration, left ventricular ejection fraction (LVEF), and systolic blood pressure. Outcomes were all-cause mortality and first hospitalization for HF or death. Of 3782 patients in sinus rhythm, median (inter-quartile range) age was 66 (58-73) years, QRS duration was 160 (146-176) ms, LVEF was 24 (20-28)%, and 78% had left bundle branch block. A multivariable model suggested that only QRS duration predicted the magnitude of the effect of CRT on outcomes. Further analysis produced estimated hazard ratios for the effect of CRT on all-cause mortality and on the composite of first hospitalization for HF or death that suggested increasing benefit with increasing QRS duration, the 95% confidence bounds excluding 1.0 at ∼140 ms for each endpoint, suggesting a high probability of substantial benefit from CRT when QRS duration exceeds this value. QRS duration is a powerful predictor of the effects of CRT on morbidity and mortality in patients with symptomatic HF and left ventricular systolic dysfunction who are in sinus rhythm. QRS morphology did not provide additional information about clinical response. NCT00170300, NCT00271154, NCT00251251.

The prognostic value of the frontal QRS-T angle is comparable to cardiovascular autonomic neuropathy regarding long-term mortality in people with diabetes. A population based study.

PubMed

May, O; Graversen, C B; Johansen, M Ø; Arildsen, H

2018-06-09

Cardiovascular autonomic neuropathy (CAN) is a well known prognostic marker in diabetes. A large angle between the QRS- and the T-wave vector (QRS-T angle) in the electrocardiogram (ECG) has recently been introduced as another marker of poor prognosis. To assess and compare the long-term predictive power of the frontal plane QRS-T angle with CAN in people with diabetes. In 1992-93 people with diabetes in the municipality of Horsens, Denmark, were identified by the prescription method andan age and gender stratified sample of 240 individuals with diabetes were randomly selected. The presence of CAN was defined using the heart rate response to Valsalva manoeuvre. The QRS-T angle was read using the method described by Gandhi. In July 2015 vital statistics were obtained fromthe Danish Civil Registration System. 178 individuals accepted to participate in the study, of which 153 (86%) completed the Valsalva manoeuvre and had sinus rhythm. Total observation time was 21.5 (0.18) years, in which 99 (65%) individuals died. An elevated QRS-T angle and the presence of cardiovascular autonomic neuropathy were both found to be significant predictors of death. In Cox regression analyses, adjusting for the effect of gender, age, duration of diabetes, BMI, total-cholesterol, diabetes type, haemoglobin A1c, smoking status, hypertension and previous MI, an independent prognostic value was found for the QRS-T angle as well as the Valsalva ratio. A large QRS-T angle and the presence of cardiovascular autonomic neuropathy are both strong and independent long-term predictors of all-cause mortality in people with diabetes. Copyright © 2018. Published by Elsevier B.V.

The Use of Epicardial Electrogram as a Simple Guide to Select the Optimal Site of Left Ventricular Pacing in Cardiac Resynchronization Therapy

PubMed Central

Fatemi, Marjaneh; Le Gal, Grégoire; Blanc, Jean-Jacques; Mansourati, Jacques; Etienne, Yves

2011-01-01

Cardiac resynchronization therapy (CRT) has been demonstrated to improve symptoms and survival in patients with left ventricular (LV) systolic dysfunction and dyssynchrony. To achieve this goal, the LV lead should be positioned in a region of delayed contraction. We hypothesized that pacing at the site of late electrical activation was also associated with long-term response to CRT. We conducted a retrospective study on 72 CRT patients. For each patient, we determined the electrical delay (ED) from the onset of QRS to the epicardial EGM and the ratio of ED to QRS duration (ED/QRS duration). After a followup of 30 ± 20 months, 47 patients responded to CRT. Responders had a significantly longer ED and greater ratio of ED/QRS duration than nonresponders. An ED/QRS duration ≥0.38 predicted a response to CRT with 89% specificity and 53% sensitivity. PMID:21403903

A 300-mV 220-nW event-driven ADC with real-time QRS detection for wearable ECG sensors.

PubMed

Zhang, Xiaoyang; Lian, Yong

2014-12-01

This paper presents an ultra-low-power event-driven analog-to-digital converter (ADC) with real-time QRS detection for wearable electrocardiogram (ECG) sensors in wireless body sensor network (WBSN) applications. Two QRS detection algorithms, pulse-triggered (PUT) and time-assisted PUT (t-PUT), are proposed based on the level-crossing events generated from the ADC. The PUT detector achieves 97.63% sensitivity and 97.33% positive prediction in simulation on the MIT-BIH Arrhythmia Database. The t-PUT improves the sensitivity and positive prediction to 97.76% and 98.59% respectively. Fabricated in 0.13 μm CMOS technology, the ADC with QRS detector consumes only 220 nW measured under 300 mV power supply, making it the first nanoWatt compact analog-to-information (A2I) converter with embedded QRS detector.

Electronic and optical properties of HEMT heterostructures with δ-Si doped GaAs/AlGaAs quantum rings — quantum well system

NASA Astrophysics Data System (ADS)

Sibirmovsky, Y. D.; Vasil'evskii, I. S.; Vinichenko, A. N.; Zhigunov, D. M.; Eremin, I. S.; Kolentsova, O. S.; Safonov, D. A.; Kargin, N. I.

2017-11-01

Samples of δ-Si doped AlGaAs/GaAs/AlGaAs HEMT heterostructures with GaAs quantum rings (QRs) on top of the quantum well (QW) were grown by molecular beam epitaxy and their properties were compared to the reference samples without QRs. The thickness of the QW was 6 - 10 nm for the samples with QRs and 20 nm for the reference samples. Photoluminescence measurements at low temperatures for all samples show at least two distinct lines in addition to the bulk GaAs line. The Hall effect and low temperature magnetotransport measurements at 4 - 320 K show that conductivity with and without illumination decreases significantly with QRs introduction, however the relative photoconductivity increases. Samples with 6 nm QW are insulating, which could be caused by the strong localization of the charge carriers in the QRs.

Iowa Child Care Quality Rating System: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Iowa's Child Care Quality Rating System prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile is divided into the following categories: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators for Family Child Care Programs;…

Louisiana Quality Start Child Care Rating System: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Louisiana's Quality Start Child Care Rating System prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs;…

New Mexico Look for the STARS--AIM HIGH: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of New Mexico's Look for the STARS--AIM HIGH prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4)…

Compendium of Quality Rating Systems and Evaluations: The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Tout, Kathryn; Starr, Rebecca; Soli, Margaret; Moodie, Shannon; Kirby, Gretchen; Boller, Kimberly

2010-01-01

Quality Rating Systems (QRS) are currently operating, under development, or being piloted in over 25 states or local areas. As the QRS model becomes integrated into the landscape of child care and education service delivery, policy, and the decisions parents make about child care across the United States, there is an increasing need for…

Los Angeles County Steps to Excellence Project: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Los Angeles County's Steps to Excellence Project prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs;…

Periodic Two-Dimensional GaAs and InGaAs Quantum Rings Grown on GaAs (001) by Droplet Epitaxy.

PubMed

Tung, Kar Hoo Patrick; Huang, Jian; Danner, Aaron

2016-06-01

Growth of ordered GaAs and InGaAs quantum rings (QRs) in a patterned SiO2 nanohole template by molecular beam epitaxy (MBE) using droplet epitaxy (DE) process is demonstrated. DE is an MBE growth technique used to fabricate quantum nanostructures of high crystal quality by supplying group III and group V elements in separate phases. In this work, ordered QRs grown on an ordered nanohole template are compared to self-assembled QRs grown with the same DE technique without the nanohole template. This study allows us to understand and compare the surface kinetics of Ga and InGa droplets when a template is present. It is found that template-grown GaAs QRs form clustered rings which can be attributed to low mobility of Ga droplets resulting in multiple nucleation sites for QR formation when As is supplied. However, the case of template-grown InGaAs QRs only one ring is formed per nanohole; no clustering is observed. The outer QR diameter is a close match to the nanohole template diameter. This can be attributed to more mobile InGa droplets, which coalesce from an Ostwald ripening to form a single large droplet before As is supplied. Thus, well-patterned InGaAs QRs are demonstrated and the kinetics of their growth are better understood which could potentially lead to improvements in the future devices that require the unique properties of patterned QRs.

A wavelet-based ECG delineation algorithm for 32-bit integer online processing

PubMed Central

2011-01-01

Background Since the first well-known electrocardiogram (ECG) delineator based on Wavelet Transform (WT) presented by Li et al. in 1995, a significant research effort has been devoted to the exploitation of this promising method. Its ability to reliably delineate the major waveform components (mono- or bi-phasic P wave, QRS, and mono- or bi-phasic T wave) would make it a suitable candidate for efficient online processing of ambulatory ECG signals. Unfortunately, previous implementations of this method adopt non-linear operators such as root mean square (RMS) or floating point algebra, which are computationally demanding. Methods This paper presents a 32-bit integer, linear algebra advanced approach to online QRS detection and P-QRS-T waves delineation of a single lead ECG signal, based on WT. Results The QRS detector performance was validated on the MIT-BIH Arrhythmia Database (sensitivity Se = 99.77%, positive predictive value P+ = 99.86%, on 109010 annotated beats) and on the European ST-T Database (Se = 99.81%, P+ = 99.56%, on 788050 annotated beats). The ECG delineator was validated on the QT Database, showing a mean error between manual and automatic annotation below 1.5 samples for all fiducial points: P-onset, P-peak, P-offset, QRS-onset, QRS-offset, T-peak, T-offset, and a mean standard deviation comparable to other established methods. Conclusions The proposed algorithm exhibits reliable QRS detection as well as accurate ECG delineation, in spite of a simple structure built on integer linear algebra. PMID:21457580

A wavelet-based ECG delineation algorithm for 32-bit integer online processing.

PubMed

Di Marco, Luigi Y; Chiari, Lorenzo

2011-04-03

Since the first well-known electrocardiogram (ECG) delineator based on Wavelet Transform (WT) presented by Li et al. in 1995, a significant research effort has been devoted to the exploitation of this promising method. Its ability to reliably delineate the major waveform components (mono- or bi-phasic P wave, QRS, and mono- or bi-phasic T wave) would make it a suitable candidate for efficient online processing of ambulatory ECG signals. Unfortunately, previous implementations of this method adopt non-linear operators such as root mean square (RMS) or floating point algebra, which are computationally demanding. This paper presents a 32-bit integer, linear algebra advanced approach to online QRS detection and P-QRS-T waves delineation of a single lead ECG signal, based on WT. The QRS detector performance was validated on the MIT-BIH Arrhythmia Database (sensitivity Se = 99.77%, positive predictive value P+ = 99.86%, on 109010 annotated beats) and on the European ST-T Database (Se = 99.81%, P+ = 99.56%, on 788050 annotated beats). The ECG delineator was validated on the QT Database, showing a mean error between manual and automatic annotation below 1.5 samples for all fiducial points: P-onset, P-peak, P-offset, QRS-onset, QRS-offset, T-peak, T-offset, and a mean standard deviation comparable to other established methods. The proposed algorithm exhibits reliable QRS detection as well as accurate ECG delineation, in spite of a simple structure built on integer linear algebra.

District of Columbia Going for the Gold Tiered Rate Reimbursement System. QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of District of Columbia's Going for the Gold Tiered Rate Reimbursement Systemp repared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for…

Issues for the Next Decade of Quality Rating and Improvement Systems. Issue Brief. Publication #2009-14

ERIC Educational Resources Information Center

Tout, Kathryn; Zaslow, Martha; Halle, Tamara; Forry, Nicole

2009-01-01

Since the first child care Quality Rating System (QRS) was implemented in Oklahoma 11 years ago (in 1998), 16 additional statewide systems have been launched and numerous states are piloting or developing a QRS (Zaslow, Tout, & Martinez-Beck, forthcoming). As QRS stakeholders across the nation look ahead to the next decade, it is important to take…

A lightweight QRS detector for single lead ECG signals using a max-min difference algorithm.

PubMed

Pandit, Diptangshu; Zhang, Li; Liu, Chengyu; Chattopadhyay, Samiran; Aslam, Nauman; Lim, Chee Peng

2017-06-01

Detection of the R-peak pertaining to the QRS complex of an ECG signal plays an important role for the diagnosis of a patient's heart condition. To accurately identify the QRS locations from the acquired raw ECG signals, we need to handle a number of challenges, which include noise, baseline wander, varying peak amplitudes, and signal abnormality. This research aims to address these challenges by developing an efficient lightweight algorithm for QRS (i.e., R-peak) detection from raw ECG signals. A lightweight real-time sliding window-based Max-Min Difference (MMD) algorithm for QRS detection from Lead II ECG signals is proposed. Targeting to achieve the best trade-off between computational efficiency and detection accuracy, the proposed algorithm consists of five key steps for QRS detection, namely, baseline correction, MMD curve generation, dynamic threshold computation, R-peak detection, and error correction. Five annotated databases from Physionet are used for evaluating the proposed algorithm in R-peak detection. Integrated with a feature extraction technique and a neural network classifier, the proposed ORS detection algorithm has also been extended to undertake normal and abnormal heartbeat detection from ECG signals. The proposed algorithm exhibits a high degree of robustness in QRS detection and achieves an average sensitivity of 99.62% and an average positive predictivity of 99.67%. Its performance compares favorably with those from the existing state-of-the-art models reported in the literature. In regards to normal and abnormal heartbeat detection, the proposed QRS detection algorithm in combination with the feature extraction technique and neural network classifier achieves an overall accuracy rate of 93.44% based on an empirical evaluation using the MIT-BIH Arrhythmia data set with 10-fold cross validation. In comparison with other related studies, the proposed algorithm offers a lightweight adaptive alternative for R-peak detection with good computational efficiency. The empirical results indicate that it not only yields a high accuracy rate in QRS detection, but also exhibits efficient computational complexity at the order of O(n), where n is the length of an ECG signal. Copyright © 2017 Elsevier B.V. All rights reserved.

Improved symptoms, physical limitation, and self-efficacy after resynchronization in a patient with heart failure and a prolonged QRS duration.

PubMed

Conaway, Darcy G; Sullivan, Robbie; McCullough, Peter A

2004-01-01

This report examines the impact of resynchronization therapy in a patient with class IV heart failure and a prolonged QRS duration on electrocardiogram. The Kansas City Cardiomyopathy Questionnaire (KCCQ) was used to assess the patient's health status prior to, immediately after, and 2 months after placement of a biventricular pacemaker. B-type natriuretic peptide (BNP) values and electrocardiogram QRS duration were recorded to further document clinical status. Our patient experienced statistically significant improvements in 7 of 10 KCCQ domains after resynchronization. QRS duration narrowed following the procedure and BNP values decreased. Resynchronization therapy improved this patient's symptoms, physical limitations, and self-efficacy when maximal medical therapy failed.

Data on association between QRS duration on prehospital ECG and mortality in patients with confirmed STEMI.

PubMed

Hansen, Rikke; Frydland, Martin; Møller-Helgestad, Ole Kristian; Lindholm, Matias Greve; Jensen, Lisette Okkels; Holmvang, Lene; Ravn, Hanne Berg; Kjærgaard, Jesper; Hassager, Christian; Møller, Jacob Eifer

2017-12-01

Data presented in this article relates to the research article entitled " Association between QRS duration on prehospital ECG and mortality in patients with suspected STEMI" (Hansen et al., in press) [1]. Data on the prognostic effect of automatically recoded QRS duration on prehospital ECG and presence of classic left and right bundle branch block in 1777 consecutive patients with confirmed ST segment elevation AMI is presented. Multivariable analysis, suggested that QRS duration >111 ms, left bundle branch block and right bundle branch block were independent predictors of 30 days all-cause mortality. For interpretation and discussion of these data, refer to the research article referenced above.

Robust QRS peak detection by multimodal information fusion of ECG and blood pressure signals.

PubMed

Ding, Quan; Bai, Yong; Erol, Yusuf Bugra; Salas-Boni, Rebeca; Zhang, Xiaorong; Hu, Xiao

2016-11-01

QRS peak detection is a challenging problem when ECG signal is corrupted. However, additional physiological signals may also provide information about the QRS position. In this study, we focus on a unique benchmark provided by PhysioNet/Computing in Cardiology Challenge 2014 and Physiological Measurement focus issue: robust detection of heart beats in multimodal data, which aimed to explore robust methods for QRS detection in multimodal physiological signals. A dataset of 200 training and 210 testing records are used, where the testing records are hidden for evaluating the performance only. An information fusion framework for robust QRS detection is proposed by leveraging existing ECG and ABP analysis tools and combining heart beats derived from different sources. Results show that our approach achieves an overall accuracy of 90.94% and 88.66% on the training and testing datasets, respectively. Furthermore, we observe expected performance at each step of the proposed approach, as an evidence of the effectiveness of our approach. Discussion on the limitations of our approach is also provided.

The value of electrocardiography for differential diagnosis in wide QRS complex tachycardia.

PubMed

Sousa, Pedro A; Pereira, Salomé; Candeias, Rui; de Jesus, Ilídio

2014-03-01

Correct diagnosis in wide QRS complex tachycardia remains a challenge. Differential diagnosis between ventricular and supraventricular tachycardia has important therapeutic and prognostic implications, and although data from clinical history and physical examination may suggest a particular origin, it is the 12-lead surface electrocardiogram that usually enables this differentiation. Since 1978, various electrocardiographic criteria have been proposed for the differential diagnosis of wide complex tachycardias, particularly the presence of atrioventricular dissociation, and the axis, duration and morphology of QRS complexes. Despite the wide variety of criteria, diagnosis is still often difficult, and errors can have serious consequences. To reduce such errors, several differential diagnosis algorithms have been proposed since 1991. However, in a small percentage of wide QRS tachycardias the diagnosis remains uncertain and in these the wisest decision is to treat them as ventricular tachycardias. The authors' objective was to review the main electrocardiographic criteria and differential diagnosis algorithms of wide QRS tachycardia. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

Atrial fibrillation with wide QRS tachycardia and undiagnosed Wolff-Parkinson-White syndrome: diagnostic and therapeutic dilemmas in a pediatric patient.

PubMed

Panduranga, Prashanth; Al-Farqani, Abdullah; Al-Rawahi, Najib

2012-11-01

A 10-year-old girl presented to the emergency department of a regional hospital with 1 episode of generalized tonic-clonic seizures. Postictal monitoring followed by a 12-lead electrocardiogram showed fast atrial fibrillation with intermittent wide QRS regular tachycardia. Immediately following this, her rhythm changed to wide QRS irregular tachycardia without hemodynamic compromise. She was suspected to have ventricular tachycardia and was treated with intravenous amiodarone with cardioversion to sinus rhythm. Subsequent electrocardiogram in sinus rhythm showed typical features of manifest Wolff-Parkinson-White (WPW) accessory pathway. This case illustrates the diagnostic and therapeutic dilemmas in patients with atrial fibrillation, wide QRS tachycardia, and undiagnosed WPW syndrome with antidromic conduction of atrial arrhythmias through the accessory pathway. Furthermore, this case demonstrates that undiagnosed wide QRS tachycardias need to be treated with drugs acting on the accessory pathway, thus keeping in mind underlying WPW syndrome as a possibility to avoid potentially catastrophic events.

QRS complex detection based on continuous density hidden Markov models using univariate observations

NASA Astrophysics Data System (ADS)

Sotelo, S.; Arenas, W.; Altuve, M.

2018-04-01

In the electrocardiogram (ECG), the detection of QRS complexes is a fundamental step in the ECG signal processing chain since it allows the determination of other characteristics waves of the ECG and provides information about heart rate variability. In this work, an automatic QRS complex detector based on continuous density hidden Markov models (HMM) is proposed. HMM were trained using univariate observation sequences taken either from QRS complexes or their derivatives. The detection approach is based on the log-likelihood comparison of the observation sequence with a fixed threshold. A sliding window was used to obtain the observation sequence to be evaluated by the model. The threshold was optimized by receiver operating characteristic curves. Sensitivity (Sen), specificity (Spc) and F1 score were used to evaluate the detection performance. The approach was validated using ECG recordings from the MIT-BIH Arrhythmia database. A 6-fold cross-validation shows that the best detection performance was achieved with 2 states HMM trained with QRS complexes sequences (Sen = 0.668, Spc = 0.360 and F1 = 0.309). We concluded that these univariate sequences provide enough information to characterize the QRS complex dynamics from HMM. Future works are directed to the use of multivariate observations to increase the detection performance.

Signal averaging technique for noninvasive recording of late potentials in patients with coronary artery disease

NASA Technical Reports Server (NTRS)

Abboud, S.; Blatt, C. M.; Lown, B.; Graboys, T. B.; Sadeh, D.; Cohen, R. J.

1987-01-01

An advanced non invasive signal averaging technique was used to detect late potentials in two groups of patients: Group A (24 patients) with coronary artery disease (CAD) and without sustained ventricular tachycardia (VT) and Group B (8 patients) with CAD and sustained VT. Recorded analog data were digitized and aligned using a cross correlation function with fast Fourier transform schema, averaged and band pass filtered between 60 and 200 Hz with a non-recursive digital filter. Averaged filtered waveforms were analyzed by computer program for 3 parameters: (1) filtered QRS (fQRS) duration (2) interval between the peak of the R wave peak and the end of fQRS (R-LP) (3) RMS value of last 40 msec of fQRS (RMS). Significant change was found between Groups A and B in fQRS (101 -/+ 13 msec vs 123 -/+ 15 msec; p < .0005) and in R-LP vs 52 -/+ 11 msec vs 71-/+18 msec, p <.002). We conclude that (1) the use of a cross correlation triggering method and non-recursive digital filter enables a reliable recording of late potentials from the body surface; (2) fQRS and R-LP durations are sensitive indicators of CAD patients susceptible to VT.

Electrocardiogram of Clinically Healthy Mithun (Bos frontalis): Variation among Strains

PubMed Central

Sanyal, Sagar; Das, Pradip Kumar; Ghosh, Probal Ranjan; Das, Kinsuk; Vupru, Kezha V.; Rajkhowa, Chandan; Mondal, Mohan

2010-01-01

A study was conducted to establish the normal electrocardiogram in four different genetic strains of mithun (Bos frontalis). Electrocardiography, cardiac electrical axis, heart rate, rectal temperature and respiration rate were recorded in a total of 32 adult male mithun of four strains (n = 8 each). It was found that the respiration and heart rates were higher (P < .05) in Manipur than other three strains. Amplitude (P < .05) and duration of P wave and QRS complex differed (P < .01) among the strains. Mizoram strain had the highest amplitude and duration of P wave and QRS complex. On the other hand, higher (P < .05) amplitude and duration of T wave were recorded in Arunachalee and Mizoram strains. The mean electrical axis of QRS complex that were recorded for Arunachalee and Manipur strains were similar to that reported for other bovine species; whereas the electrical axis of QRS for Nagamese and Mizoram strains were more close to feline and caprine species, respectively. In conclusion, electrocardiogram of mithun revealed that the amplitude and duration of P wave, QRS complex and T wave were different among four different genetic strains of mithun and the electrical axis of QRS complex for Nagamese and Mizoram mithuns are dissimilar to bovine species. PMID:20886013

Comparison of QRS Duration and Associated Cardiovascular Events in American Indian Men Versus Women (The Strong Heart Study).

PubMed

Deen, Jason F; Rhoades, Dorothy A; Noonan, Carolyn; Best, Lyle G; Okin, Peter M; Devereux, Richard B; Umans, Jason G

2017-06-01

Electrocardiographic QRS duration at rest is associated with sudden cardiac death and death from coronary heart disease in the general population. However, its relation to cardiovascular events in American Indians, a population with persistently high cardiovascular disease mortality, is unknown. The relation of QRS duration to incident cardiovascular disease during 17.2 years of follow-up was assessed in 1,851 male and female Strong Heart Study participants aged 45 to 74 years without known cardiovascular disease at baseline. Cox regression with robust standard error estimates was used to determine the association between quintiles of QRS duration and incident cardiovascular disease in gender-stratified analyses, adjusted for age, systolic blood pressure, hypertension, antihypertensive medication use, body mass index, current smoking, diabetes, total cholesterol, high-density lipoprotein cholesterol, and albuminuria. In women only, QRS duration in the highest quintile (≥105 ms) conferred significantly higher risk of cardiovascular disease than QRS duration in the lowest quintile (64 to 84 ms) (hazard ratio 1.6, 95% CI 1.1 to 2.4) likely because of higher risks of coronary heart disease (hazard ratio 1.8, 95% CI 1.1 to 3.1) and myocardial infarction (hazard ratio 2.1, 95% CI 1.0 to 4.7). Furthermore, when added to the Strong Heart Study Coronary Heart Disease Risk Calculator, QRS duration significantly improved prediction of future coronary heart disease events in women (Net Reclassification Index 0.17, 95% CI 0.06 to 0.47). In conclusion, QRS duration is an independent predictor of cardiovascular disease in women in the Strong Heart Study cohort and may have value in estimating risk in populations with similar risk profiles and a high lifetime incidence of cardiovascular disease. Copyright © 2017 Elsevier Inc. All rights reserved.

NeutrAvidin Functionalization of CdSe/CdS Quantum Nanorods and Quantification of Biotin Binding Sites using Biotin-4-Fluorescein Fluorescence Quenching.

PubMed

Lippert, Lisa G; Hallock, Jeffrey T; Dadosh, Tali; Diroll, Benjamin T; Murray, Christopher B; Goldman, Yale E

2016-03-16

We developed methods to solubilize, coat, and functionalize with NeutrAvidin elongated semiconductor nanocrystals (quantum nanorods, QRs) for use in single molecule polarized fluorescence microscopy. Three different ligands were compared with regard to efficacy for attaching NeutrAvidin using the "zero-length cross-linker" 1-ethyl-3-[3-(dimethylamino)propyl]carbodiimide (EDC). Biotin-4-fluorescene (B4F), a fluorophore that is quenched when bound to avidin proteins, was used to quantify biotin binding activity of the NeutrAvidin coated QRs and biotin binding activity of commercially available streptavidin coated quantum dots (QDs). All three coating methods produced QRs with NeutrAvidin coating density comparable to the streptavidin coating density of the commercially available quantum dots (QDs) in the B4F assay. One type of QD available from the supplier (ITK QDs) exhibited ∼5-fold higher streptavidin surface density compared to our QRs, whereas the other type of QD (PEG QDs) had 5-fold lower density. The number of streptavidins per QD increased from ∼7 streptavidin tetramers for the smallest QDs emitting fluorescence at 525 nm (QD525) to ∼20 tetramers for larger, longer wavelength QDs (QD655, QD705, and QD800). QRs coated with NeutrAvidin using mercaptoundecanoicacid (MUA) and QDs coated with streptavidin bound to biotinylated cytoplasmic dynein in single molecule TIRF microscopy assays, whereas Poly(maleic anhydride-alt-1-ocatdecene) (PMAOD) or glutathione (GSH) QRs did not bind cytoplasmic dynein. The coating methods require optimization of conditions and concentrations to balance between substantial NeutrAvidin binding vs tendency of QRs to aggregate and degrade over time.

A deep learning approach for fetal QRS complex detection.

PubMed

Zhong, Wei; Liao, Lijuan; Guo, Xuemei; Wang, Guoli

2018-04-20

Non-invasive foetal electrocardiography (NI-FECG) has the potential to provide more additional clinical information for detecting and diagnosing fetal diseases. We propose and demonstrate a deep learning approach for fetal QRS complex detection from raw NI-FECG signals by using a convolutional neural network (CNN) model. The main objective is to investigate whether reliable fetal QRS complex detection performance can still be obtained from features of single-channel NI-FECG signals, without canceling maternal ECG (MECG) signals. A deep learning method is proposed for recognizing fetal QRS complexes. Firstly, we collect data from set-a of the PhysioNet/computing in Cardiology Challenge database. The sample entropy method is used for signal quality assessment. Part of the bad quality signals is excluded in the further analysis. Secondly, in the proposed method, the features of raw NI-FECG signals are normalized before they are fed to a CNN classifier to perform fetal QRS complex detection. We use precision, recall, F-measure and accuracy as the evaluation metrics to assess the performance of fetal QRS complex detection. The proposed deep learning method can achieve relatively high precision (75.33%), recall (80.54%), and F-measure scores (77.85%) compared with three other well-known pattern classification methods, namely KNN, naive Bayes and SVM. the proposed deep learning method can attain reliable fetal QRS complex detection performance from the raw NI-FECG signals without canceling MECG signals. In addition, the influence of different activation functions and signal quality assessment on classification performance are evaluated, and results show that Relu outperforms the Sigmoid and Tanh on this particular task, and better classification performance is obtained with the signal quality assessment step in this study.

Association between obesity and ECG variables in children and adolescents: A cross-sectional study.

PubMed

Sun, Guo-Zhe; Li, Yang; Zhou, Xing-Hu; Guo, Xiao-Fan; Zhang, Xin-Gang; Zheng, Li-Qiang; Li, Yuan; Jiao, Yun-DI; Sun, Ying-Xian

2013-12-01

Obesity exhibits a wide variety of electrocardiogram (ECG) abnormalities in adults, which often lead to cardiovascular events. However, there is currently no evidence of an association between obesity and ECG variables in children and adolescents. The present study aimed to explore the associations between obesity and ECG intervals and axes in children and adolescents. A cross-sectional observational study of 5,556 students aged 5-18 years was performed. Anthropometric data, blood pressure and standard 12-lead ECGs were collected for each participant. ECG variables were measured manually based on the temporal alignment of simultaneous 12 leads using a CV200 ECG Work Station. Overweight and obese groups demonstrated significantly longer PR intervals, wider QRS durations and leftward shifts of frontal P-wave, QRS and T-wave axes, while the obese group also demonstrated significantly higher heart rates, compared with normal weight groups within normotensive or hypertensive subjects (P<0.05). Abdominal obesity was also associated with longer PR intervals, wider QRS duration and a leftward shift of frontal ECG axes compared with normal waist circumference (WC) within normotensive or hypertensive subjects (P<0.05). Gender was a possible factor affecting the ECG variables. Furthermore, the ECG variables, including PR interval, QRS duration and frontal P-wave, QRS and T-wave axes, were significantly linearly correlated with body mass index, WC and waist-to-height ratio adjusted for age, gender, ethnicity and blood pressure. However, there was no significant association between obesity and the corrected QT interval (P>0.05). The results of the current study indicate that in children and adolescents, general and abdominal obesity is associated with longer PR intervals, wider QRS duration and a leftward shift of frontal P-wave, QRS and T-wave axes, independent of age, gender, ethnicity and blood pressure.

Real-Time 12-Lead High-Frequency QRS Electrocardiography for Enhanced Detection of Myocardial Ischemia and Coronary Artery Disease

NASA Technical Reports Server (NTRS)

Schlegel, Todd T.; Kulecz, Walter B.; DePalma, Jude L.; Feiveson, Alan H.; Wilson, John S.; Rahman, M. Atiar; Bungo, Michael W.

2004-01-01

Several studies have shown that diminution of the high-frequency (HF; 150-250 Hz) components present within the central portion of the QRS complex of an electrocardiogram (ECG) is a more sensitive indicator for the presence of myocardial ischemia than are changes in the ST segments of the conventional low-frequency ECG. However, until now, no device has been capable of displaying, in real time on a beat-to-beat basis, changes in these HF QRS ECG components in a continuously monitored patient. Although several software programs have been designed to acquire the HF components over the entire QRS interval, such programs have involved laborious off-line calculations and postprocessing, limiting their clinical utility. We describe a personal computer-based ECG software program developed recently at the National Aeronautics and Space Administration (NASA) that acquires, analyzes, and displays HF QRS components in each of the 12 conventional ECG leads in real time. The system also updates these signals and their related derived parameters in real time on a beat-to-beat basis for any chosen monitoring period and simultaneously displays the diagnostic information from the conventional (low-frequency) 12-lead ECG. The real-time NASA HF QRS ECG software is being evaluated currently in multiple clinical settings in North America. We describe its potential usefulness in the diagnosis of myocardial ischemia and coronary artery disease.

Low QRS Voltage on Presenting Electrocardiogram Predicts Multi-vessel Disease in Anterior ST-segment Elevation Myocardial Infarction.

PubMed

Kobayashi, Akihiro; Misumida, Naoki; Aoi, Shunsuke; Kanei, Yumiko

Low QRS voltage was reported to predict adverse outcomes in acute myocardial infarction in the pre-thrombolytic era. However, the association between low voltage and angiographic findings has not been fully addressed. We performed a retrospective analysis of patients with anterior ST-segment elevation myocardial infarction (STEMI). Low QRS voltage was defined as either peak to peak QRS complex voltage <1.0mV in all precordial leads or <0.5mV in all limb leads. Among 190 patients, 37 patients (19%) had low voltage. Patients with low voltage had a higher rate of multi-vessel disease (MVD) (76% vs. 52%, p=0.01). Patients with low voltage were more likely to undergo coronary artery bypass grafting (CABG) during admission (11% vs. 2%, p=0.028). Low voltage was an independent predictor for MVD (OR 2.50; 95% CI 1.12 to 6.03; p=0.032). Low QRS voltage was associated with MVD and in-hospital CABG in anterior STEMI. Copyright © 2017 Elsevier Inc. All rights reserved.

Associations of electrocardiographic P-wave characteristics with left atrial function, and diffuse left ventricular fibrosis defined by cardiac magnetic resonance: The PRIMERI Study.

PubMed

Tiffany Win, Theingi; Ambale Venkatesh, Bharath; Volpe, Gustavo J; Mewton, Nathan; Rizzi, Patricia; Sharma, Ravi K; Strauss, David G; Lima, Joao A; Tereshchenko, Larisa G

2015-01-01

Abnormal P-terminal force in lead V1 (PTFV1) is associated with an increased risk of heart failure, stroke, atrial fibrillation, and death. Our goal was to explore associations of left ventricular (LV) diffuse fibrosis with left atrial (LA) function and electrocardiographic (ECG) measures of LA electrical activity. Patients without atrial fibrillation (n = 91; mean age 59.5 years; 61.5% men; 65.9% white) with structural heart disease (spatial QRS-T angle ≥105° and/or Selvester QRS score ≥5 on ECG) but LV ejection fraction >35% underwent clinical evaluation, cardiac magnetic resonance, and resting ECG. LA function indices were obtained by multimodality tissue tracking using 2- and 4-chamber long-axis images. T1 mapping and late gadolinium enhancement were used to assess diffuse LV fibrosis and presence of scar. P-prime in V1 amplitude (PPaV1) and duration (PPdV1), averaged P-wave-duration, PR interval, and P-wave axis were automatically measured using 12 SLTM algorithm. PTFV1 was calculated as a product of PPaV1 and PPdV1. In linear regression after adjustment for demographic characteristics, body mass index, maximum LA volume index, presence of scar, and LV mass index, each decile increase in LV interstitial fibrosis was associated with 0.76 mV*ms increase in negative abnormal PTFV1 (95% confidence interval [CI] -1.42 to -0.09; P = .025), 15.3 ms prolongation of PPdV1 (95% CI 6.9 to 23.8; P = .001) and 5.4 ms prolongation of averaged P-duration (95% CI 0.9-10.0; P = .020). LV fibrosis did not affect LA function. PPaV1 and PTFV1 were associated with an increase in LA volumes and decrease in LA emptying fraction and LA reservoir function. LV interstitial fibrosis is associated with abnormal PTFV1, prolonged PPdV1, and P-duration, but does not affect LA function. Copyright © 2015 Heart Rhythm Society. All rights reserved.

Wolff-Parkinson-White (WPW) syndrome: the detection of delta wave in an electrocardiogram (ECG).

PubMed

Mahamat, Hassan Adam; Jacquir, Sabir; Khalil, Cliff; Laurent, Gabriel; Binczak, Stephane

2016-08-01

The delta wave remains an important indicator to diagnose the WPW syndrome. In this paper, a new method of detection of delta wave in an ECG signal is proposed. Firstly, using the continuous wavelet transform, the P wave, the QRS complex and the T wave are detected, then their durations are computed after determination of the boundary location (onsets and offsets of the P, QRS and T waves). Secondly, the PR duration, the QRS duration and the upstroke of the QRS complex are used to determine the presence or absence of the delta wave. This algorithm has been tested on the Physionel database (ptbdb) in order to evaluate its robustness. It has been applied to clinical signals from patients affected by WPW syndrome. This method can provide assistance to practitioners in order to detect the WPW syndrome.

Absorption enhancement in type-II coupled quantum rings due to existence of quasi-bound states

NASA Astrophysics Data System (ADS)

Hsieh, Chi-Ti; Lin, Shih-Yen; Chang, Shu-Wei

2018-02-01

The absorption of type-II nanostructures is often weaker than type-I counterpart due to spatially separated electrons and holes. We model the bound-to-continuum absorption of type-II quantum rings (QRs) using a multiband source-radiation approach using the retarded Green function in the cylindrical coordinate system. The selection rules due to the circular symmetry for allowed transitions of absorption are utilized. The bound-tocontinuum absorptions of type-II GaSb coupled and uncoupled QRs embedded in GaAs matrix are compared here. The GaSb QRs act as energy barriers for electrons but potential wells for holes. For the coupled QR structure, the region sandwiched between two QRs forms a potential reservoir of quasi-bound electrons. Electrons in these states, though look like bound ones, would ultimately tunnel out of the reservoir through barriers. Multiband perfectly-matched layers are introduced to model the tunneling of quasi-bound states into open space. Resonance peaks are observed on the absorption spectra of type-II coupled QRs due to the formation of quasi-bound states in conduction bands, but no resonance exist in the uncoupled QR. The tunneling time of these metastable states can be extracted from the resonance and is in the order of ten femtoseconds. Absorption of coupled QRs is significantly enhanced as compared to that of uncoupled ones in certain spectral windows of interest. These features may improve the performance of photon detectors and photovoltaic devices based on type-II semiconductor nanostructures.

QRS Detection Algorithm for Telehealth Electrocardiogram Recordings.

PubMed

Khamis, Heba; Weiss, Robert; Xie, Yang; Chang, Chan-Wei; Lovell, Nigel H; Redmond, Stephen J

2016-07-01

QRS detection algorithms are needed to analyze electrocardiogram (ECG) recordings generated in telehealth environments. However, the numerous published QRS detectors focus on clean clinical data. Here, a "UNSW" QRS detection algorithm is described that is suitable for clinical ECG and also poorer quality telehealth ECG. The UNSW algorithm generates a feature signal containing information about ECG amplitude and derivative, which is filtered according to its frequency content and an adaptive threshold is applied. The algorithm was tested on clinical and telehealth ECG and the QRS detection performance is compared to the Pan-Tompkins (PT) and Gutiérrez-Rivas (GR) algorithm. For the MIT-BIH Arrhythmia database (virtually artifact free, clinical ECG), the overall sensitivity (Se) and positive predictivity (+P) of the UNSW algorithm was >99%, which was comparable to PT and GR. When applied to the MIT-BIH noise stress test database (clinical ECG with added calibrated noise) after artifact masking, all three algorithms had overall Se >99%, and the UNSW algorithm had higher +P (98%, p < 0.05) than PT and GR. For 250 telehealth ECG records (unsupervised recordings; dry metal electrodes), the UNSW algorithm had 98% Se and 95% +P which was superior to PT (+P: p < 0.001) and GR (Se and +P: p < 0.001). This is the first study to describe a QRS detection algorithm for telehealth data and evaluate it on clinical and telehealth ECG with superior results to published algorithms. The UNSW algorithm could be used to manage increasing telehealth ECG analysis workloads.

Distribution and determinants of QRS rotation of black and white persons in the general population.

PubMed

Prineas, Ronald J; Zhang, Zhu-Ming; Stevens, Cladd E; Soliman, Elsayed Z

The prevalence and determinants of QRS transition zones are not well established. We examined the distributions of Normal, clockwise (CW) and counterclockwise (CCW)) QRS transition zones and their relations to disease, body size and demographics in 4624 black and white men and women free of cardiovascular disease and major ECG abnormalities enrolled in the NHANES-III survey. CW transition zones were least observed (6.2%) and CCW were most prevalent (60.1%) with Normal in an intermediate position (33.7%). In multivariable logistic regression analysis, the adjusted, significant predictors for CCW compared to Normal were a greater proportion of blacks and women, fewer thin people (BMI<20, thin), a greater ratio of chest depth to chest width, and an LVMass index <80g. By contrast, CW persons were older, had larger QRS/T angles, smaller ratio of chest depth to chest width, had a greater proportion of subjects with low voltage QRS, more pulmonary disease, a greater proportion with high heart rates, shorter QRS duration and were more obese (BMI≥30). Normal rather than being the most prevalent transition zone was intermediate in frequency between the most frequently encountered CCW and the least frequently encountered transition zone CW. Differences in the predictors of CW and CCW exist. This requires further investigation to examine how far these differences explain the differences in the published prognostic differences between CW and CCW. Copyright © 2017 Elsevier Inc. All rights reserved.

Association of Age, Sex, Body Size and Ethnicity with Electrocardiographic Values in Community-based Older Asian Adults.

PubMed

Tan, Eugene S J; Yap, Jonathan; Xu, Chang Fen; Feng, Liang; Nyunt, Shwe Zin; Santhanakrishnan, Rajalakshmi; Chan, Michelle M Y; Seow, Swee Chong; Ching, Chi Keong; Yeo, Khung Keong; Richards, A Mark; Ng, Tze Pin; Lim, Toon Wei; Lam, Carolyn S P

2016-07-01

Existing electrocardiographic (ECG) reference values were derived in middle-aged Caucasian adults. We aimed to assess the association of age, sex, body size and ethnicity on ECG parameters in a multi-ethnic Asian population. Resting 12-lead ECG and anthropometric measurements were performed in a community-based cohort of 3777 older Asians (age 64.7±9.1 years, 1467 men, 88.8% Chinese, 7.7% Malay, 3.5% Indian, body mass index [BMI] 24.0±3.9kg/m(2)). Men had longer PR interval, wider QRS, shorter QTc interval and taller SV3. In both sexes, older age was associated with longer PR interval, wider QRS, larger R aVL and more leftward QRS axis, while higher BMI was associated with longer PR interval, wider QRS, larger RaVL and more negative QRS axis. There were significant inter-ethnic differences in QRS duration among men, as well as in PR and QTc intervals among women (all adjusted p<0.05). Findings were similar in a healthy subset of 1158 adults (age 61.2±9.1 years, 365 men) without cardiovascular risk factors. These first community-based ECG data in multi-ethnic older Asians highlight the independent effects of age, sex, body size and ethnicity on ECG parameters. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Analysis of the QRS complex for apnea-bradycardia characterization in preterm infants

PubMed Central

Altuve, Miguel; Carrault, Guy; Cruz, Julio; Beuchée, Alain; Pladys, Patrick; Hernandez, Alfredo I.

2009-01-01

This work presents an analysis of the information content of new features derived from the electrocardiogram (ECG) for the characterization of apnea-bradycardia events in preterm infants. Automatic beat detection and segmentation methods have been adapted to the ECG signals from preterm infants, through the application of two evolutionary algorithms. ECG data acquired from 32 preterm infants with persistent apnea-bradycardia have been used for quantitative evaluation. The adaptation procedure led to an improved sensitivity and positive predictive value, and a reduced jitter for the detection of the R-wave, QRS onset, QRS offset, and iso-electric level. Additionally, time series representing the RR interval, R-wave amplitude and QRS duration, were automatically extracted for periods at rest, before, during and after apnea-bradycardia episodes. Significant variations (p<0.05) were observed for all time-series when comparing the difference between values at rest versus values just before the bradycardia event, with the difference between values at rest versus values during the bradycardia event. These results reveal changes in the R-wave amplitude and QRS duration, appearing at the onset and termination of apnea-bradycardia episodes, which could be potentially useful for the early detection and characterization of these episodes. PMID:19963984

Revisiting QRS detection methodologies for portable, wearable, battery-operated, and wireless ECG systems.

PubMed

Elgendi, Mohamed; Eskofier, Björn; Dokos, Socrates; Abbott, Derek

2014-01-01

Cardiovascular diseases are the number one cause of death worldwide. Currently, portable battery-operated systems such as mobile phones with wireless ECG sensors have the potential to be used in continuous cardiac function assessment that can be easily integrated into daily life. These portable point-of-care diagnostic systems can therefore help unveil and treat cardiovascular diseases. The basis for ECG analysis is a robust detection of the prominent QRS complex, as well as other ECG signal characteristics. However, it is not clear from the literature which ECG analysis algorithms are suited for an implementation on a mobile device. We investigate current QRS detection algorithms based on three assessment criteria: 1) robustness to noise, 2) parameter choice, and 3) numerical efficiency, in order to target a universal fast-robust detector. Furthermore, existing QRS detection algorithms may provide an acceptable solution only on small segments of ECG signals, within a certain amplitude range, or amid particular types of arrhythmia and/or noise. These issues are discussed in the context of a comparison with the most conventional algorithms, followed by future recommendations for developing reliable QRS detection schemes suitable for implementation on battery-operated mobile devices.

Revisiting QRS Detection Methodologies for Portable, Wearable, Battery-Operated, and Wireless ECG Systems

PubMed Central

Elgendi, Mohamed; Eskofier, Björn; Dokos, Socrates; Abbott, Derek

2014-01-01

Cardiovascular diseases are the number one cause of death worldwide. Currently, portable battery-operated systems such as mobile phones with wireless ECG sensors have the potential to be used in continuous cardiac function assessment that can be easily integrated into daily life. These portable point-of-care diagnostic systems can therefore help unveil and treat cardiovascular diseases. The basis for ECG analysis is a robust detection of the prominent QRS complex, as well as other ECG signal characteristics. However, it is not clear from the literature which ECG analysis algorithms are suited for an implementation on a mobile device. We investigate current QRS detection algorithms based on three assessment criteria: 1) robustness to noise, 2) parameter choice, and 3) numerical efficiency, in order to target a universal fast-robust detector. Furthermore, existing QRS detection algorithms may provide an acceptable solution only on small segments of ECG signals, within a certain amplitude range, or amid particular types of arrhythmia and/or noise. These issues are discussed in the context of a comparison with the most conventional algorithms, followed by future recommendations for developing reliable QRS detection schemes suitable for implementation on battery-operated mobile devices. PMID:24409290

Helium diffusion experiments on synthetic apatite crystals and single-grain fragments: can we retrieve the He diffusion profiles?

NASA Astrophysics Data System (ADS)

Kasanzu, C.; Beucher, R.; Brown, R. W.; Persano, C.; Stuart, F.

2011-12-01

Apatite (U-Th)/he thermochronometry is one of the most widely used methods of quantifying thermal histories of rocks within the vicinity of the surface. Theoretical and practical development carried out during the last decade, among which was the release of affordable LASERs, have led to standard practice of analyzing single grain rather than multigrain aliquots. The standard theoretical basis for interpreting these ages assumes that the technique is used on full grains. However, the natural weak cleavage of apatite leads to fragmentation of these individual prismatic crystals during the rock crushing and mineral separation process. Apatites are most often broken along a weak cleavage perpendicular to the c-axis. It is therefore common practice to analyze fragments of whole grains, not complete crystals. It is also well known that dating often leads to single ages being more dispersed than expected whatever the efforts to avoid perturbations on the He system. Using a theoretical numerical model and considering both axial and radial diffusion, we demonstrate thata largepart (most?) of the dispersion is due to analyses of single apatite fragments. This effect is larger for older grains which have exprienced a slow cooling history and have well rounded diffusive profiles. Ages are a strongfunction of the fragment size (length specifically), we show that ages from apatite fragments with 1 prismatic termination (1T) can be used to retrieve the helium diffusion profile, provided a sufficient number of single fragment analyses are carried out. The shape of the helium diffusion profile provides a strong constraint on the style of the thermal history and so we propose to use single crystal fragment analyses to extract a mean diffusion profile, and deduce the thermal history of the sample. In order to test these ideas, we performed a set of experiments with natural samples and semi-synthetic grains of apatite. Synthetic grains are obtained by drilling cores of various length/width ratios within standard Durango crystals while natural grains are separated from a deep borehole in south-Africa (BK1) and from the Australian craton. Several experiences are presented: 1) (U-Th)/He dating of about 100 1T single-fragment aliquots of different shape ratio from the BK1 borehole; 2) (U-Th)/He dating of 20 2T single-fragment aliquot from an Australian sample previously dated following standard procedure. 3) (U-Th)/He dating of synthetic fragmentsfrom synthetic grains previously degassed by a known percentageusing a thermo-regulated furnace. The results of the experiments lead to important new insight into the natural dispersion of (U-Th)/He single-grain ages. They show that far from being problematic, highly dispersed data may indeed contain first-order information on the thermal history of rocks. We discuss all the details of the standard (U-Th)/He approach such as the effects of temporally variable diffusivity (e.g. radiation damage models), zonation of U and Th and arbitrary grain size variations.

Differentiating the origin of outflow tract ventricular arrhythmia using a simple, novel approach.

PubMed

Efimova, Elena; Dinov, Borislav; Acou, Willem-Jan; Schirripa, Valentina; Kornej, Jelena; Kosiuk, Jedrzej; Rolf, Sascha; Sommer, Philipp; Richter, Sergio; Bollmann, Andreas; Hindricks, Gerhard; Arya, Arash

2015-07-01

Numerous electrocardiographic (ECG) criteria have been proposed to identify localization of outflow tract ventricular arrhythmias (OT-VAs); however, in some cases, it is difficult to accurately localize the origin of OT-VA using the surface ECG. The purpose of this study was to assess a simple criterion for localization of OT-VAs during electrophysiology study. We measured the interval from the onset of the earliest QRS complex of premature ventricular contractions (PVCs) to the distal right ventricular apical signal (the QRS-RVA interval) in 66 patients (31 men aged 53.3 ± 14.0 years; right ventricular outflow tract [RVOT] origin in 37) referred for ablation of symptomatic outflow tract PVCs. We prospectively validated this criterion in 39 patients (22 men aged 52 ± 15 years; RVOT origin in 19). Compared with patients with RVOT PVCs, the QRS-RVA interval was significantly longer in patients with left ventricular outflow tract (LVOT) PVCs (70 ± 14 vs 33.4±10 ms, P < .001). Receiver operating characteristic analysis showed that a QRS-RVA interval ≥49 ms had sensitivity, specificity, and positive and negative predictive values of 100%, 94.6%, 93.5%, and 100%, respectively, for prediction of an LVOT origin. The same analysis in the validation cohort showed sensitivity, specificity, and positive and negative predictive values of 94.7%, 95%, 95%, and 94.7%, respectively. When these data were combined, a QRS-RVA interval ≥49 ms had sensitivity, specificity, and positive and negative predictive values of 98%, 94.6%, 94.1%, and 98.1%, respectively, for prediction of an LVOT origin. A QRS-RVA interval ≥49 ms suggests an LVOT origin. The QRS-RVA interval is a simple and accurate criterion for differentiating the origin of outflow tract arrhythmia during electrophysiology study; however, the accuracy of this criterion in identifying OT-VA from the right coronary cusp is limited. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Comparison of the QRS Complex, ST-Segment, and T-Wave Among Patients with Left Bundle Branch Block with and without Acute Myocardial Infarction.

PubMed

Dodd, Kenneth W; Elm, Kendra D; Smith, Stephen W

2016-07-01

The modified Sgarbossa criteria have been validated as a rule for diagnosis of acute coronary occlusion (ACO) in left bundle branch block (LBBB). However, no analysis has been done on differences in the QRS complex, T-wave, or ST-segment concordance of < 1 mm in the derivation or validation studies. Furthermore, there was no comparison of patients with acute myocardial infarction (AMI) but without ACO (i.e., non-ST-elevation myocardial infarction [non-STEMI]) to patients with ACO or without AMI (no MI). We compare findings involving the QRS amplitude, ST-segment morphology, ST-concordance < 1 mm, and T-waves in patients with LBBB with ACO, non-STEMI, and no MI. Retrospectively, emergency department patients were identified with LBBB and ischemic symptoms but no MI, with angiographically proven ACO, and with non-STEMI. ACO, non-STEMI, and no MI groups consisted of 33, 24, and 105 patients. The sum of the maximum deflection of the QRS amplitude across all leads (ΣQRS) was smaller in patients with ACO than those without ACO (101.5 mm vs. 132.5 mm; p < 0.0001) and a cutoff of ΣQRS < 90 mm was 92% specific. For ACO, non-concave ST-segment morphology was 91% specific, any ST concordance ≥ 1 mm was 95% specific, and any ST concordance ≥ 0.5 mm was 94% sensitive. For non-STEMI, terminal T-wave concordance, analogous to biphasic T-waves, was moderately sensitive at 79%. We found differences in QRS amplitude, ST-segment morphology, and T-waves between patients with LBBB and ACO, non-STEMI, and no MI. However, none of these criteria outperformed the modified Sgarbossa criteria for diagnosis of ACO in LBBB. Copyright © 2016 Elsevier Inc. All rights reserved.

Epsilon wave on an electronic loop in a case of arrhythmogenic right ventricular dysplasia with myocarditis: an updated definition of the Epsilon wave.

PubMed

Fontaine, Guy Hugues; Duthoit, Guillaume; Li, Guoliang; Andreoletti, L; Gandjbakhch, Estelle; Frank, Robert

2017-07-01

A young man presented with a history of myocarditis with palpitations and dizziness. He had implantation of a loop recorder that showed repetitive short episodes of VT. In addition, there were fragmented potentials immediately following the large and sharp electrograms (EGMs) before as well as after episodes of VT suggesting an Epsilon wave. This signal can be observed in multiple cardiac conditions including coronary artery disease. It was originally recorded on the epicardium as well as on the endocardium. However, in ARVD it can be defined as an electric signal observed after the end of the QRS complex in the right as opposed to the left precordial leads (difference ≥ 25 ms). It can also be an aid to the diagnosis of patients with ARVD who have other signs or symptoms suggesting ARVD including episodes of myocarditis. This potential consists of a slurring at the end of the QRS complex or an independent potential after the return to the isoelectric line. It can be better observed by increasing amplification of the ECG tracing as well as double speed using the Fontaine lead system. Epsilon wave too small to be recorded on the standard ECG can be extracted by Signal Averaging ECG SAECG). Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For Permissions, please email: journals.permissions@oup.com.

Microcontroller-based real-time QRS detection.

PubMed

Sun, Y; Suppappola, S; Wrublewski, T A

1992-01-01

The authors describe the design of a system for real-time detection of QRS complexes in the electrocardiogram based on a single-chip microcontroller (Motorola 68HC811). A systematic analysis of the instrumentation requirements for QRS detection and of the various design techniques is also given. Detection algorithms using different nonlinear transforms for the enhancement of QRS complexes are evaluated by using the ECG database of the American Heart Association. The results show that the nonlinear transform involving multiplication of three adjacent, sign-consistent differences in the time domain gives a good performance and a quick response. When implemented with an appropriate sampling rate, this algorithm is also capable of rejecting pacemaker spikes. The eight-bit single-chip microcontroller provides sufficient throughput and shows a satisfactory performance. Implementation of multiple detection algorithms in the same system improves flexibility and reliability. The low chip count in the design also favors maintainability and cost-effectiveness.

The electrical heart axis and ST events in fetal monitoring: A post-hoc analysis following a multicentre randomised controlled trial.

PubMed

Vullings, Rik; Verdurmen, Kim M J; Hulsenboom, Alexandra D J; Scheffer, Stephanie; de Lau, Hinke; Kwee, Anneke; Wijn, Pieter F F; Amer-Wåhlin, Isis; van Laar, Judith O E H; Oei, S Guid

2017-01-01

Reducing perinatal morbidity and mortality is one of the major challenges in modern health care. Analysing the ST segment of the fetal electrocardiogram was thought to be the breakthrough in fetal monitoring during labour. However, its implementation in clinical practice yields many false alarms and ST monitoring is highly dependent on cardiotocogram assessment, limiting its value for the prediction of fetal distress during labour. This study aims to evaluate the relation between physiological variations in the orientation of the fetal electrical heart axis and the occurrence of ST events. A post-hoc analysis was performed following a multicentre randomised controlled trial, including 1097 patients from two participating centres. All women were monitored with ST analysis during labour. Cases of fetal metabolic acidosis, poor signal quality, missing blood gas analysis, and congenital heart disease were excluded. The orientation of the fetal electrical heart axis affects the height of the initial T/QRS baseline, and therefore the incidence of ST events. We grouped tracings with the same initial baseline T/QRS value. We depicted the number of ST events as a function of the initial baseline T/QRS value with a linear regression model. A significant increment of ST events was observed with increasing height of the initial T/QRS baseline, irrespective of the fetal condition; correlation coefficient 0.63, p<0.001. The most frequent T/QRS baseline is 0.12. The orientation of the fetal electrical heart axis and accordingly the height of the initial T/QRS baseline should be taken into account in fetal monitoring with ST analysis.

Universal algorithm for diagnosis of biventricular capture in patients with cardiac resynchronization therapy.

PubMed

Jastrzebski, Marek; Kukla, Piotr; Fijorek, Kamil; Czarnecka, Danuta

2014-08-01

An accurate and universal method for diagnosis of biventricular (BiV) capture using a standard 12-lead electrocardiogram (ECG) would be useful for assessment of cardiac resynchronization therapy (CRT) patients. Our objective was to develop and validate such an ECG method for BiV capture diagnosis that would be independent of pacing lead positions-a major confounder that significantly influences the morphologies of paced QRS complexes. On the basis of an evaluation of 789 ECGs of 443 patients with heart failure and various right ventricular (RV) and left ventricular (LV) lead positions, the following algorithm was constructed and validated. BiV capture was diagnosed if the QRS in lead I was predominantly negative and either V1 QRS was predominantly positive or V6 QRS was of negative onset and predominantly negative (step 1), or if QRS complex duration was <160 ms (step 2). All other ECGs were classified as loss of LV capture. The algorithm showed good accuracy (93%), sensitivity (97%), and specificity (90%) for detection of loss of LV capture. The performance of the algorithm did not differ among apical, midseptal, and outflow tract RV lead positions and various LV lead positions. LV capture leaves diagnostic hallmarks in the fused BiV QRS related to different vectors of depolarization and more rapid depolarization of the ventricles. An accurate two-step ECG algorithm for BiV capture diagnosis was developed and validated. This algorithm is universally applicable to all CRT patients, regardless of the positions of the pacing leads. ©2014 Wiley Periodicals, Inc.

Assessments of the QT/QRS restitution in perfused guinea-pig heart can discriminate safe and arrhythmogenic drugs.

PubMed

Osadchii, Oleg E

2017-09-01

Drug-induced arrhythmia remains a matter of serious clinical concern, partly due to low prognostic value of currently available arrhythmic biomarkers. This study examined whether arrhythmogenic risks can be predicted through assessments of the rate adaptation of QT interval, ventricular effective refractory period (ERP), or the QT/QRS ratio, in perfused guinea-pig hearts. When the maximum restitution slope was taken as a metric of proarrhythmia, neither QT interval nor ERP measurements at progressively increased pacing rates were found to fully discriminate arrhythmogenic drugs (dofetilide, quinidine, flecainide, and procainamide) from those recognized as safe antiarrhythmics (lidocaine and mexiletine). For example, the slope of QT restitution was increased by dofetilide and quinidine, but remained unchanged by flecainide, procainamide, lidocaine, and mexiletine. With ERP rate adaptation, even though the restitution slope was increased by dofetilide, all class I agents reduced the slope value independently of their safety profile. The QRS measurements revealed variable drug effects, ranging from significant use-dependent conduction slowing (flecainide, quinidine, and procainamide) to only modest increase in QRS (lidocaine and mexiletine), or no change at all (dofetilide). However, with the QT/QRS rate adaptation, the restitution slope was significantly increased by all agents which have been reported to produce proarrhythmic effects (dofetilide, quinidine, flecainide, and procainamide), but not changed by lidocaine and mexiletine. These findings suggest that the slope of the QT/QRS rate adaptation can be considered as a novel electrophysiological biomarker in predicting potential arrhythmic risks associated with pharmacotherapy in cardiac patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Analysis of the temporal regression of the QRS widening induced by bupivacaine after Intralipid administration. Study in an experimental porcine model.

PubMed

Zaballos, M; Sevilla, R; González, J; Callejo, D; de Diego, C; Almendral, J; Quintela, O; Anadón, M J

2016-01-01

The principal mechanism of cardiac toxicity of bupivacaine relates to the blockade of myocardial sodium channels, which leads to an increase in the QRS duration. Recently, experimental studies suggest that lipid emulsion is effective in reversing bupivacaine cardiac toxicity. We aimed to evaluate the temporal evolution of the QRS widening induced by bupivacaine with the administration of Intralipid. Twelve pigs were anesthetized with intravenous sodium thiopental 5mg kg(-1) and sevoflurane 1 MAC (2.6%). Femoral artery and vein were canalized for invasive monitoring, analysis of blood gases and determination of bupivacaine levels. After instrumentation and monitoring, a bupivacaine bolus of 4-6 mg kg(-1) was administered in order to induce a 150% increase in QRS duration (defined as the toxic point). The pigs were randomized into two groups of six individuals. Intralipid group (IL) received 1.5 mL kg(-1)of IL over one minute, followed by an infusion of 0.25 mL kg min(-1). Control group (C) received the same volume of a saline solution. The electrocardiographic parameters were recorded, and blood samples were taken after bupivacaine and 1, 5, 10 and 30 minutes after Intralipid/saline administration. Bupivacaine (4.33±0.81 mg/kg in IL group and 4.66±1.15 mg/kg in C group) induced similar electrocardiographic changes in both groups; mean maximal percent increase in QRS interval was 184±62% in IL group, and 230±56% in control group (NS). Lipid administration reversed the QRS widening previously impaired by bupivacaine. After ten minutes of the administration of IL, the mean QRS interval decreased to 132±56% vs. 15±76% relative to the maximum widening induced by bupivacaine, in IL and C group, respectively. Intralipid reversed the lengthening of QRS interval induced by the injection of bupivacaine. Time to normalization of electrocardiographic parameters can last more than 10 minutes. While the phenomena of cardiac toxicity persist, resuscitation measures and adequate monitoring should be continued until adequate heart conduction parameters are restored. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

Identification of QRS complex in non-stationary electrocardiogram of sick infants.

PubMed

Kota, S; Swisher, C B; Al-Shargabi, T; Andescavage, N; du Plessis, A; Govindan, R B

2017-08-01

Due to the high-frequency of routine interventions in an intensive care setting, electrocardiogram (ECG) recordings from sick infants are highly non-stationary, with recurrent changes in the baseline, alterations in the morphology of the waveform, and attenuations of the signal strength. Current methods lack reliability in identifying QRS complexes (a marker of individual cardiac cycles) in the non-stationary ECG. In the current study we address this problem by proposing a novel approach to QRS complex identification. Our approach employs lowpass filtering, half-wave rectification, and the use of instantaneous Hilbert phase to identify QRS complexes in the ECG. We demonstrate the application of this method using ECG recordings from eight preterm infants undergoing intensive care, as well as from 18 normal adult volunteers available via a public database. We compared our approach to the commonly used approaches including Pan and Tompkins (PT), gqrs, wavedet, and wqrs for identifying QRS complexes and then compared each with manually identified QRS complexes. For preterm infants, a comparison between the QRS complexes identified by our approach and those identified through manual annotations yielded sensitivity and positive predictive values of 99% and 99.91%, respectively. The comparison metrics for each method are as follows: PT (sensitivity: 84.49%, positive predictive value: 99.88%), gqrs (85.25%, 99.49%), wavedet (95.24%, 99.86%), and wqrs (96.99%, 96.55%). Thus, the sensitivity values of the four methods previously described, are lower than the sensitivity of the method we propose; however, the positive predictive values of these other approaches is comparable to those of our method, with the exception of the wqrs approach, which yielded a slightly lower value. For adult ECG, our approach yielded a sensitivity of 99.78%, whereas PT yielded 99.79%. The positive predictive value was 99.42% for both our approach as well as for PT. We propose a novel method for identifying QRS complexes that outperforms common currently available tools for non-stationary ECG data in infants. For stationary ECG our proposed approach and the PT approach perform equally well. The ECG acquired in a clinical environment may be prone to issues related to non-stationarity, especially in critically ill patients. The approach proposed in this report offers superior reliability in these scenarios. Copyright © 2017 Elsevier Ltd. All rights reserved.

Aggregation-fragmentation-diffusion model for trail dynamics

DOE PAGES

Kawagoe, Kyle; Huber, Greg; Pradas, Marc; ...

2017-07-21

We investigate statistical properties of trails formed by a random process incorporating aggregation, fragmentation, and diffusion. In this stochastic process, which takes place in one spatial dimension, two neighboring trails may combine to form a larger one, and also one trail may split into two. In addition, trails move diffusively. The model is defined by two parameters which quantify the fragmentation rate and the fragment size. In the long-time limit, the system reaches a steady state, and our focus is the limiting distribution of trail weights. We find that the density of trail weight has power-law tail P(w)~w –γ formore » small weight w. We obtain the exponent γ analytically and find that it varies continuously with the two model parameters. In conclusion, the exponent γ can be positive or negative, so that in one range of parameters small-weight trails are abundant and in the complementary range they are rare.« less

Epitaxial growth of quantum rods with high aspect ratio and compositional contrast

DOE Office of Scientific and Technical Information (OSTI.GOV)

Li, L. H.; Patriarche, G.; Fiore, A.

2008-12-01

The epitaxial growth of quantum rods (QRs) on GaAs was investigated. It was found that GaAs thickness in the GaAs/InAs superlattice used for QR formation plays a key role in improving the QR structural properties. Increasing the GaAs thickness results in both an increased In compositional contrast between the QRs and surrounding layer, and an increased QR length. QRs with an aspect ratio of up to 10 were obtained, representing quasiquantum wires in a GaAs matrix. Due to modified confinement and strain potential, such nanostructure is promising for controlling gain polarization.

A narrow QRS tachycardia and cannon A waves: What is the mechanism?

PubMed

Ali, Hussam; Epicoco, Gianluca; De Ambroggi, Guido; Lupo, Pierpaolo; Foresti, Sara; Cappato, Riccardo

2017-07-01

Regular narrow QRS tachycardia, particularly if well-tolerated, is usually considered a "benign" arrhythmia of a supraventricular origin. This case concerns an 82-year-old male with ischemic heart disease who presented with recurrent episodes of a narrow QRS tachycardia that was initially diagnosed and treated as atrial tachyarrhythmia. However, careful physical examination and ECG analysis established the correct diagnosis, and the patient was managed appropriately. Remarkably, the observation of irregular cannon A waves, and Lewis lead recording, confirmed atrioventricular dissociation during tachycardia and indicated its underlying mechanism. © 2016 Wiley Periodicals, Inc.

Incorrect electrode cable connection during electrocardiographic recording.

PubMed

Batchvarov, Velislav N; Malik, Marek; Camm, A John

2007-11-01

Incorrect electrode cable connections during electrocardiographic (ECG) recording can simulate rhythm or conduction disturbance, myocardial ischaemia and infarction, as well as other clinically important abnormalities. When only precordial or only limb cables, excluding the neutral cable, have been interchanged the waveforms in the different leads are re-arranged, inverted, or unchanged, whereas the duration of intervals is not changed. The mistake can be recognized by the presence of unusual P-QRS patterns (e.g. negative P-QRS in lead I or II, positive in lead AVR, P-QRS complexes of opposite direction in leads I and V6, etc.), change in the P-QRS axis, or abnormal precordial QRS-T wave progression. Interchange of limb cables with the neutral cable distorts Wilson's terminal and the morphology of all precordial and unipolar limb leads. The telltale sign of the mistake is the presence of (almost) a flat line in lead I, II or III. Interchange of even one of the limb cables, except for the neutral cable, with a precordial cable distorts the morphology of most leads and leaves not more than one lead (I, II, or III) unchanged. Computerized algorithms for detection of lead misplacement, such as those based on artificial neural networks, or on correlation between original and reconstructed leads, have been developed.

Detection of segments with fetal QRS complex from abdominal maternal ECG recordings using support vector machine

NASA Astrophysics Data System (ADS)

Delgado, Juan A.; Altuve, Miguel; Nabhan Homsi, Masun

2015-12-01

This paper introduces a robust method based on the Support Vector Machine (SVM) algorithm to detect the presence of Fetal QRS (fQRS) complexes in electrocardiogram (ECG) recordings provided by the PhysioNet/CinC challenge 2013. ECG signals are first segmented into contiguous frames of 250 ms duration and then labeled in six classes. Fetal segments are tagged according to the position of fQRS complex within each one. Next, segment features extraction and dimensionality reduction are obtained by applying principal component analysis on Haar-wavelet transform. After that, two sub-datasets are generated to separate representative segments from atypical ones. Imbalanced class problem is dealt by applying sampling without replacement on each sub-dataset. Finally, two SVMs are trained and cross-validated using the two balanced sub-datasets separately. Experimental results show that the proposed approach achieves high performance rates in fetal heartbeats detection that reach up to 90.95% of accuracy, 92.16% of sensitivity, 88.51% of specificity, 94.13% of positive predictive value and 84.96% of negative predictive value. A comparative study is also carried out to show the performance of other two machine learning algorithms for fQRS complex estimation, which are K-nearest neighborhood and Bayesian network.

The effect of catastrophic collisional fragmentation and diffuse medium accretion on a computational interstellar dust system

NASA Technical Reports Server (NTRS)

Liffman, Kurt

1990-01-01

The effects of catastrophic collisional fragmentation and diffuse medium accretion on a the interstellar dust system are computed using a Monte Carlo computer model. The Monte Carlo code has as its basis an analytic solution of the bulk chemical evolution of a two-phase interstellar medium, described by Liffman and Clayton (1989). The model is subjected to numerous different interstellar processes as it transfers from one interstellar phase to another. Collisional fragmentation was found to be the dominant physical process that shapes the size spectrum of interstellar dust. It was found that, in the diffuse cloud phase, 90 percent of the refractory material is locked up in the dust grains, primarily due to accretion in the molecular medium. This result is consistent with the observed depletions of silicon. Depletions were found to be affected only slightly by diffuse cloud accretion.

Clinical and electrophysiological characteristics of patients with paroxysmal intra-His block with narrow QRS complexes.

PubMed

Ragupathi, Loheetha; Johnson, Drew; Greenspon, Arnold; Frisch, Daniel; Ho, Reginald T; Pavri, Behzad B

2018-04-18

Atrioventricular (AV) block is usually due to infranodal disease and associated with a wide QRS complex; such patients often progress to complete AV block and pacemaker dependency. Uncommonly, infranodal AV block can occur within the His bundle with a narrow QRS complex. The aims of this study were to define clinical/echocardiographic characteristics of patients with AV block within the His bundle and report progression to pacemaker dependency. We retrospectively identified patients with narrow QRS complexes and documented intra-His delay or block at electrophysiology study (group A) or with electrocardiogram-documented Mobitz II AV block/paroxysmal AV block (group B). Clinical, electrophysiological, and echocardiographic variables at presentation and pacemaker parameters at the last follow-up visit were evaluated. Twenty-seven patients (19 women) were identified (mean age 64 ± 13 years; range, 38-85 years). Four patients who had <1 month of follow-up were excluded. There were 12 patients in group A and 11 in group B; 21 of 23 presented with syncope/presyncope. All patients received pacemakers: 8 single chamber and 15 dual chamber. After a median follow-up of 6.4 years, the median percentage of ventricular pacing was 1% (interquartile range 0%-4.66%). One patient developed true pacemaker dependency. Aortic and/or mitral annular calcification was present in 13 of 22 patients with available echocardiograms. Patients who present with syncope and narrow QRS complexes with intra-His delay or Mobitz II paroxysmal AV block with narrow QRS complexes rarely progress to pacemaker dependency and require infrequent pacing. This entity is more common in women, with a higher prevalence of aortic and/or mitral annular calcification. If confirmed by additional studies, single-chamber pacemaker may be sufficient. Copyright © 2018 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Sympathetic neural activation does not mediate heart rate variability during repeated brief umbilical cord occlusions in near-term fetal sheep.

PubMed

Lear, Christopher A; Galinsky, Robert; Wassink, Guido; Mitchell, Clinton J; Davidson, Joanne O; Westgate, Jennifer A; Bennet, Laura; Gunn, Alistair J

2016-03-01

Changes in fetal heart rate variability (FHRV) and ST segment elevation (measured as the T/QRS ratio) are used to evaluate fetal adaptation to labour. The sympathetic nervous system (SNS) is an important contributor to FHRV under healthy normoxic conditions, and is critical for rapid support of blood pressure during brief labour-like asphyxia. However, although it has been assumed that SNS activity contributes to FHRV during labour; this has never been tested, and it is unclear whether the SNS contributes to the rapid increase in T/QRS ratio during brief asphyxia. Thirteen chronically instrumented fetal sheep at 0.85 of gestation received either chemical sympathectomy with 6-hydroxydopamine (6-OHDA; n = 6) or sham treatment (control; n = 7), followed 4-5 days later by 2 min episodes of complete umbilical cord occlusion repeated every 5 min for up to 4 h, or until mean arterial blood pressure fell to <20 mmHg for two successive occlusions. FHRV was decreased before occlusions in the 6-OHDA group (P < 0.05) and 2-4.5 h during recovery after occlusions (P < 0.05) compared to the control group. During each occlusion there was a rapid increase in T/QRS ratio. Between successive occlusions the T/QRS ratio rapidly returned to baseline, and FHRV increased above baseline in both groups (P < 0.05), with no significant effect of sympathectomy on FHRV or T/QRS ratio. In conclusion, these data show that SNS activity does not mediate the increase in FHRV between repeated episodes of brief umbilical cord occlusion or the transient increase in T/QRS ratio during occlusions. © 2015 The Authors. The Journal of Physiology © 2015 The Physiological Society.

Right precordial-directed electrocardiographical markers identify arrhythmogenic right ventricular cardiomyopathy in the absence of conventional depolarization or repolarization abnormalities.

PubMed

Cortez, Daniel; Svensson, Anneli; Carlson, Jonas; Graw, Sharon; Sharma, Nandita; Brun, Francesca; Spezzacatene, Anita; Mestroni, Luisa; Platonov, Pyotr G

2017-10-13

Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) carries a risk of sudden death. We aimed to assess whether vectorcardiographic (VCG) parameters directed toward the right heart and a measured angle of the S-wave would help differentiate ARVD/C with otherwise normal electrocardiograms from controls. Task Force 2010 definite ARVD/C criteria were met for all patients. Those who did not fulfill Task Force depolarization or repolarization criteria (-ECG) were compared with age and gender-matched control subjects. Electrocardiogram measures of a 3-dimentional spatial QRS-T angle, a right-precordial-directed orthogonal QRS-T (RPD) angle, a root mean square of the right sided depolarizing forces (RtRMS-QRS), QRS duration (QRSd) and the corrected QT interval (QTc), and a measured angle including the upslope and downslope of the S-wave (S-wave angle) were assessed. Definite ARVD/C was present in 155 patients by 2010 Task Force criteria (41.7 ± 17.6 years, 65.2% male). -ECG ARVD/C patients (66 patients) were compared to 66 control patients (41.7 ± 17.6 years, 65.2% male). All parameters tested except the QRSd and QTc significantly differentiated -ECG ARVD/C from control patients (p < 0.004 to p < 0.001). The RPD angle and RtRMS-QRS best differentiated the groups. Combined, the 2 novel criteria gave 81.8% sensitivity, 90.9% specificity and odds ratio of 45.0 (95% confidence interval 15.8 to 128.2). ARVD/C disease process may lead to development of subtle ECG abnormalities that can be distinguishable using right-sided VCG or measured angle markers better than the spatial QRS-T angle, the QRSd or QTc, in the absence of Taskforce ECG criteria.

Summation and Cancellation Effects on QRS and ST-Segment Changes Induced by Simultaneous Regional Myocardial Ischemia.

PubMed

Vives-Borrás, Miquel; Jorge, Esther; Amorós-Figueras, Gerard; Millán, Xavier; Arzamendi, Dabit; Cinca, Juan

2018-01-01

Simultaneous ischemia in two myocardial regions is a potentially lethal clinical condition often unrecognized whose corresponding electrocardiographic (ECG) patterns have not yet been characterized. Thus, this study aimed to determine the QRS complex and ST-segment changes induced by concurrent ischemia in different myocardial regions elicited by combined double occlusion of the three main coronary arteries. For this purpose, 12 swine were randomized to combination of 5-min single and double coronary artery occlusion: Group 1: left Circumflex (LCX) and right (RCA) coronary arteries ( n = 4); Group 2: left anterior descending artery (LAD) and LCX ( n = 4) and; Group 3: LAD and RCA ( n = 4). QRS duration and ST-segment displacement were measured in 15-lead ECG. As compared with single occlusion, double LCX+RCA blockade induced significant QRS widening of about 40 ms in nearly all ECG leads and magnification of the ST-segment depression in leads V1-V3 (maximal 228% in lead V3, p < 0.05). In contrast, LAD+LCX or LAD+RCA did not induce significant QRS widening and markedly attenuated the ST-segment elevation in precordial leads (maximal attenuation of 60% in lead V3 in LAD+LCX and 86% in lead V5 in LAD+RCA, p < 0.05). ST-segment elevation in leads V7-V9 was a specific sign of single LCX occlusion. In conclusion, concurrent infero-lateral ischemia was associated with a marked summation effect of the ECG changes previously elicited by each single ischemic region. By contrast, a cancellation effect on ST-segment changes with no QRS widening was observed when the left anterior descending artery was involved.

The roles of the Q (q) wave in lead I and QRS frontal axis for diagnosing loss of left ventricular capture during cardiac resynchronization therapy.

PubMed

Cao, Yuan-Yuan; Su, Yan-Gang; Bai, Jin; Wang, Wei; Wang, Jing-Feng; Qin, Sheng-Mei; Ge, Jun-Bo

2015-01-01

Loss of left ventricular (LV) capture may lead to deterioration of heart failure in patients with cardiac resynchronization therapy (CRT). Recognition of loss of LV capture in time is important in clinical practice. A total of 422 electrocardiograms were acquired and analyzed from 53 CRT patients at 8 different pacing settings (LV only, right ventricle [RV] only, biventricular [BV] pacing with LV preactivation of 60, 40, 20, and 0 milliseconds and RV preactivation of 20 and 40 milliseconds). A modified Ammann algorithm by adding a third step-presence of Q (q, or QS) wave-to the original 2-step Ammann algorithm and a QRS axis shift method were devised to identify the loss of LV capture. The accuracy of modified Ammann algorithm was significantly higher than that of Ammann algorithm (78.9% vs. 69.1%, P < 0.001). The accuracy of the axis shift method was 66.4%, which was significantly lower than the modified Ammann algorithm (P < 0.001) and similar to the original one (P = 0.412). However, in the ECGs with QRS axis shift, 96.8% were correctly classified. LV preactivation or simultaneous BV activation and LV lead positioned in nonposterior or noninferior wall could elevate the accuracies of the modified Ammann algorithm and the QRS axis shift method. The accuracy of the modified Ammann algorithm is greatly improved. The QRS axis shift method can help diagnose LV capture. The LV preactivation, or simultaneous BV activation and LV lead positioned in nonposterior or noninferior wall can increase the diagnostic power of the modified Ammann algorithm and QRS axis shift method. © 2014 Wiley Periodicals, Inc.

Electrocardiographic signal-averaging during atrial pacing and effect of cycle length on the terminal QRS in patients with and without inducible ventricular tachycardia.

PubMed

Kremers, M S; Black, W H; Lange, R; Wells, P J; Solo, M

1990-11-01

Electrocardiographic signal-averaging during sinus rhythm (61 to 99 beats/min) and atrial pacing (100 to 171 beats/min) were performed to determine the effect of heart rate on late potentials in 15 patients without (group 1) and 7 patients with (group 2) inducible sustained ventricular tachycardia (VT). In sinus rhythm (79 +/- 12 vs 77 +/- 12 beats/min, difference not significant), the duration of the low-amplitude signal less than 40 microV was longer in group 2 than group 1 (43 +/- 21 vs 26 +/- 8 ms, p = 0.034) and more patients had late potentials (57 vs 7%, p = 0.021), but QRS duration (121 +/- 32 vs 98 +/- 19 ms) and terminal voltage (33 +/- 33 vs 50 +/- 26 ms) were not significantly different. With atrial pacing in group 1 (128 +/- 16 beats/min), 3 patients developed a simultaneous decrease in terminal voltage and an increase in terminal QRS duration consistent with a late potential, but mean total and terminal durations were unchanged. Terminal voltage increased (50 +/- 26 to 59 +/- 40) but not significantly. With atrial pacing in group 2 (119 +/- 12 beats/min) all patients either had a late potential or developed a simultaneous decrease in terminal voltage and an increase in terminal QRS duration (p = 0.001 vs group 1). Root mean square (p = 0.001 vs group 1). Root mean square voltage decreased (33 +/- 23 to 22 +/- 23) and became significantly different from group 1 (p = 0.017). Mean QRS duration, root mean square terminal voltage and low-amplitude terminal QRS duration, however, were unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)

Dynamics and rate-dependence of the spatial angle between ventricular depolarization and repolarization wave fronts during exercise ECG.

PubMed

Kenttä, Tuomas; Karsikas, Mari; Kiviniemi, Antti; Tulppo, Mikko; Seppänen, Tapio; Huikuri, Heikki V

2010-07-01

QRS/T angle and the cosine of the angle between QRS and T-wave vectors (TCRT), measured from standard 12-lead electrocardiogram (ECG), have been used in risk stratification of patients. This study assessed the possible rate dependence of these variables during exercise ECG in healthy subjects. Forty healthy volunteers, 20 men and 20 women, aged 34.6 +/- 3.4, underwent an exercise ECG testing. Twelve-lead ECG was recorded from each test subject and the spatial QRS/T angle and TCRT were automatically analyzed in a beat-to-beat manner with custom-made software. The individual TCRT/RR and QRST/RR patterns were fitted with seven different regression models, including a linear model and six nonlinear models. TCRT and QRS/T angle showed a significant rate dependence, with decreased values at higher heart rates (HR). In individual subjects, the second-degree polynomic model was the best regression model for TCRT/RR and QRST/RR slopes. It provided the best fit for both exercise and recovery. The overall TCRT/RR and QRST/RR slopes were similar between men and women during exercise and recovery. However, women had predominantly higher TCRT and QRS/T values. With respect to time, the dynamics of TCRT differed significantly between men and women; with a steeper exercise slope in women (women, -0.04/min vs -0.02/min in men, P < 0.0001). In addition, evident hysteresis was observed in the TCRT/RR slopes; with higher TCRT values during exercise. The individual patterns of TCRT and QRS/T angle are affected by HR and gender. Delayed rate adaptation creates hysteresis in the TCRT/RR slopes.

Prognostic value of predischarge electrocardiographic measurement of infarct size after thrombolysis: insights from GUSTO I Economics and Quality of Life substudy.

PubMed

Barbagelata, Alejandro; Califf, Robert M; Sgarbossa, Elena B; Knight, David; Mark, Daniel B; Granger, Christopher B; Armstrong, Paul W; Elizari, Marcelo; Birnbaum, Yochai; Grinfeld, Liliana R; Ohman, E Magnus; Wagner, Galen S

2004-11-01

Current methods for risk stratification after acute myocardial infarction (MI) include several noninvasive studies. In this cost-containment era, the development of low-cost means should be encouraged. We assessed the ability of an electrocardiogram (ECG) MI-sizing score to predict outcomes in patients enrolled in the Economics and Quality of Life (EQOL) sub study of the Global Utilization of Streptokinase and Tissue plasminogen activator for Occluded coronary arteries -I (GUSTO-I) trial. We classified patients by electrocardiographic Selvester QRS score at hospital discharge: those with a score 0-9 versus > or =10. Endpoints were 30-day and 1-year mortality, resource use, and quality-of-life measures. Patients with a QRS score <10 were well-matched with those with QRS score > or =10 with the exception of a trend to more anterior MI in the higher scored group. Patients with QRS score > or =10 had increased risk of death at 30-days (8.9% vs. 2.9% P < .001), and this difference persisted at 1 year (12.6% vs. 5.4%, P = .001). Recurrent chest pain, use of angiography, and angioplasty were similar during follow-up. However, there was a trend toward less coronary bypass surgery in patients with a QRS score > or =10. Readmission rates were higher at 30 days but similar at 1 year. Stratification of patients after acute MI by a simple measure of MI size identifies populations with different long-term prognoses; patients with a QRS score > or =10 (approximately 30% of the left ventricle infarcted) at discharge have poorer outcomes in both the short- and long-term. The standard 12-lead ECG provides a simple, economical means of risk stratification at discharge.

Conductive atomic force microscopy studies on the transformation of GeSi quantum dots to quantum rings.

PubMed

Zhang, S L; Xue, F; Wu, R; Cui, J; Jiang, Z M; Yang, X J

2009-04-01

Conductive atomic force microscopy has been employed to study the topography and conductance distribution of individual GeSi quantum dots (QDs) and quantum rings (QRs) during the transformation from QDs to QRs by depositing an Si capping layer on QDs. The current distribution changes significantly with the topographic transformation during the Si capping process. Without the capping layer, the QDs are dome-shaped and the conductance is higher at the ring region between the center and boundary than that at the center. After capping with 0.32 nm Si, the shape of the QDs changes to pyramidal and the current is higher at both the center and the arris. When the Si capping layer increases to 2 nm, QRs are formed and the current of individual QRs is higher at the rim than that at the central hole. By comparing the composition distributions obtained by scanning Auger microscopy and atomic force microscopy combined with selective chemical etching, the origin of the current distribution change is discussed.

Cardiac conductive disturbance in patients with polycystic ovary syndrome.

PubMed

Huang, Jen-Hung; Tsai, Jen-Chen; Hsu, Ming-I; Chen, Yi-Jen

2010-12-01

Polycystic ovary syndrome (PCOS) is the most common endocrine abnormality of reproductive-aged women and increases the risk of cardiovascular disease. However, the effects of PCOS on electrocardiograms (ECGs) are not fully elucidated. The aim of this study was to evaluate the characteristics of ECGs in patients with PCOS. This study included 24 patients with PCOS and 12 patients without PCOS. The heart rate, PR interval, QRS duration, Sokolow-Lyon voltage (SV1 + RV5/6), Cornell voltage (RaVL + SV3), QT interval and QTc interval were measured in 12-lead ECGs. The QRS duration was wider in patients with PCOS than those without PCOS (91 ± 8 vs. 81 ± 10 ms, p < 0.05). The heart rate, PR interval, Sokolow-Lyon voltage, product of the QRS duration times Cornell voltage combination, QT interval, QTc interval, QT dispersion and QTc dispersion were similar between the two groups. PCOS is associated with a widening QRS duration, which may contribute to its increased cardiovascular risks.

High-frequency Electrocardiogram Analysis in the Ability to Predict Reversible Perfusion Defects during Adenosine Myocardial Perfusion Imaging

NASA Technical Reports Server (NTRS)

Tragardh, Elin; Schlegel, Todd T.; Carlsson, Marcus; Pettersson, Jonas; Nilsson, Klas; Pahlm, Olle

2007-01-01

Background: A previous study has shown that analysis of high-frequency QRS components (HF-QRS) is highly sensitive and reasonably specific for detecting reversible perfusion defects on myocardial perfusion imaging (MPI) scans during adenosine. The purpose of the present study was to try to reproduce those findings. Methods: 12-lead high-resolution electrocardiogram recordings were obtained from 100 patients before (baseline) and during adenosine Tc-99m-tetrofosmin MPI tests. HF-QRS were analyzed regarding morphology and changes in root mean square (RMS) voltages from before the adenosine infusion to peak infusion. Results: The best area under the curve (AUC) was found in supine patients (AUC=0.736) in a combination of morphology and RMS changes. None of the measurements, however, were statistically better than tossing a coin (AUC=0.5). Conclusion: Analysis of HF-QRS was not significantly better than tossing a coin for determining reversible perfusion defects on MPI scans.

QRS slopes for assessment of myocardial damage in chronic chagasic patients

NASA Astrophysics Data System (ADS)

Pueyo, E.; Laciar, E.; Anzuola, E.; Laguna, P.; Jané, R.

2007-11-01

In this study the slopes of the QRS complex are evaluated for determination of the degree of myocardial damage in chronic chagasic patients. Previous studies have demonstrated the ability of the slope indices to reflect alterations in the conduction velocity of the cardiac impulse. Results obtained in the present study show that chronic chagasic patients have significantly flatter QRS slopes as compared to healthy subjects. Not only that but the extent of slope lessening turns out to be proportional to the degree of myocardial damage caused by the disease. Additionally, when incorporating the slope indices into a classification analysis together with other indices indicative of the presence of ventricular late potentials obtained from high resolution electrocardiography, results show that the percentages of correct classification increase up to 62.5%, which means eight points above the percentages obtained prior to incorporation of the slope indices. It can be concluded that QRS slopes have great potential for assessing the degree of severity associated with Chagas' disease.

Reproducibility of HTS-SQUID magnetocardiography in an unshielded clinical environment.

PubMed

Leder, U; Schrey, F; Haueisen, J; Dörrer, L; Schreiber, J; Liehr, M; Schwarz, G; Solbrig, O; Figulla, H R; Seidel, P

2001-07-01

A new technology has been developed which measures the magnetic field of the human heart (magnetocardiogram, MCG) by using high temperature superconducting (HTS) sensors. These sensors can be operated at the temperature of liquid nitrogen without electromagnetic shielding. We tested the reproducibility of HTS-MCG measurements in healthy volunteers. Unshielded HTS-MCG measurements were performed in 18 healthy volunteers in left precordial position in two separate sessions in a clinical environment. The heart cycles of 10 min were averaged, smoothed, the baselines were adjusted, and the data were standardized to the respective areas under the curves (AUC) of the absolute values of the QRST amplitudes. The QRS complexes and the ST-T intervals were used to assess the reproducibility of the two measurements. Ratios (R(QRS), R(STT)) were calculated by dividing the AUC of the first measurement by the ones of the second measurement. The linear correlation coefficients (CORR(QRS), CORR(STT)) of the time intervals of the two measurements were calculated, too. The HTS-MCG signal was completely concealed by the high noise level in the raw data. The averaging and smoothing algorithms unmasked the QRS complex and the ST segment. A high reproducibility was found for the QRS complex (R(QRS)=1.2+/-0.3, CORR(QRS)=0.96+/-0.06). Similarly to the shape of the ECG it was characterized by three bends, the Q, R, and S waves. In the ST-T interval, the reproducibility was considerably lower (R(STT)=0.9+/-0.2, CORR(STT)=0.66+/-0.28). In contrast to the shape of the ECG, a baseline deflection after the T wave which may belong to U wave activity was found in a number of volunteers. HTS-MCG devices can be operated in a clinical environment without shielding. Whereas the reproducibility was found to be high for the depolarization interval, it was considerably lower for the ST segment and for the T wave. Therefore, before clinically applying HTS-MCG systems to the detection of repolarization abnormalities in acute coronary syndromes, further technical development of the systems is necessary to improve the signal-to-noise ratio.

Aviation System Analysis Capability Quick Response System Report for Fiscal Year 1998

NASA Technical Reports Server (NTRS)

Ege, Russell; Villani, James; Ritter, Paul

1999-01-01

This document presents the additions and modifications made to the Quick Response System (QRS) in FY 1998 in support of the ASAC QRS development effort. this Document builds upon the Aviation System Analysis Capability Quick Responses System Report for Fiscal Year 1997.

Anisotropic Brownian motion in ordered phases of DNA fragments.

PubMed

Dobrindt, J; Rodrigo Teixeira da Silva, E; Alves, C; Oliveira, C L P; Nallet, F; Andreoli de Oliveira, E; Navailles, L

2012-01-01

Using Fluorescence Recovery After Photobleaching, we investigate the Brownian motion of DNA rod-like fragments in two distinct anisotropic phases with a local nematic symmetry. The height of the measurement volume ensures the averaging of the anisotropy of the in-plane diffusive motion parallel or perpendicular to the local nematic director in aligned domains. Still, as shown in using a model specifically designed to handle such a situation and predicting a non-Gaussian shape for the bleached spot as fluorescence recovery proceeds, the two distinct diffusion coefficients of the DNA particles can be retrieved from data analysis. In the first system investigated (a ternary DNA-lipid lamellar complex), the magnitude and anisotropy of the diffusion coefficient of the DNA fragments confined by the lipid bilayers are obtained for the first time. In the second, binary DNA-solvent system, the magnitude of the diffusion coefficient is found to decrease markedly as DNA concentration is increased from isotropic to cholesteric phase. In addition, the diffusion coefficient anisotropy measured within cholesteric domains in the phase coexistence region increases with concentration, and eventually reaches a high value in the cholesteric phase.

Combined assessment of myocardial damage and electrical disturbance in chronic heart failure

PubMed Central

Kadowaki, Shinpei; Watanabe, Tetsu; Otaki, Yoichiro; Narumi, Taro; Honda, Yuki; Takahashi, Hiroki; Arimoto, Takanori; Shishido, Tetsuro; Miyamoto, Takuya; Kubota, Isao

2017-01-01

AIM To investigate feasibility of combined assessment of biochemical and electrophysiological myocardial impairment markers risk-stratifying patients with chronic heart failure (CHF). METHODS Serum levels of heart-type fatty acid binding protein (H-FABP) as a marker of ongoing myocardial damage and QRS duration on electrocardiogram were measured at admission in 322 consecutive patients with CHF. A prolonged QRS duration was defined as 120 ms or longer. The cut-off value for H-FABP level (4.5 ng/mL) was determined from a previous study. Patients were prospectively followed during a median follow up period of 534 d. The primary endpoint was cardiac deaths and rehospitalization for worsening CHF. RESULTS There were 117 primary events, including 27 cardiac deaths and 90 rehospitalizations. Patients were stratified into four groups according to H-FABP level and QRS duration (≥ 120 ms). Multivariate analysis demonstrated that high H-FABP levels [hazard ratio (HR) = 1.745, P = 0.021] and QRS prolongation (HR 1.612, P = 0.0258) were independent predictors of cardiac events. Kaplan-Meier analysis demonstrated that the combination of high H-FABP levels and QRS prolongation could be used to reliably stratify patients at high risk for cardiac events (log rank test P < 0.0001). CONCLUSION Combined assessment of myocardial damage and electrical disturbance can be used to risk-stratify patients with CHF. PMID:28603594

Fetal QRS detection and heart rate estimation: a wavelet-based approach.

PubMed

Almeida, Rute; Gonçalves, Hernâni; Bernardes, João; Rocha, Ana Paula

2014-08-01

Fetal heart rate monitoring is used for pregnancy surveillance in obstetric units all over the world but in spite of recent advances in analysis methods, there are still inherent technical limitations that bound its contribution to the improvement of perinatal indicators. In this work, a previously published wavelet transform based QRS detector, validated over standard electrocardiogram (ECG) databases, is adapted to fetal QRS detection over abdominal fetal ECG. Maternal ECG waves were first located using the original detector and afterwards a version with parameters adapted for fetal physiology was applied to detect fetal QRS, excluding signal singularities associated with maternal heartbeats. Single lead (SL) based marks were combined in a single annotator with post processing rules (SLR) from which fetal RR and fetal heart rate (FHR) measures can be computed. Data from PhysioNet with reference fetal QRS locations was considered for validation, with SLR outperforming SL including ICA based detections. The error in estimated FHR using SLR was lower than 20 bpm for more than 80% of the processed files. The median error in 1 min based FHR estimation was 0.13 bpm, with a correlation between reference and estimated FHR of 0.48, which increased to 0.73 when considering only records for which estimated FHR > 110 bpm. This allows us to conclude that the proposed methodology is able to provide a clinically useful estimation of the FHR.

Diagnostic electrocardiographic dyad criteria of emphysema in left ventricular hypertrophy

PubMed Central

Lanjewar, Swapnil S; Chhabra, Lovely; Chaubey, Vinod K; Joshi, Saurabh; Kulkarni, Ganesh; Kothagundla, Chandrasekhar; Kaul, Sudesh; Spodick, David H

2013-01-01

Background The electrocardiographic diagnostic dyad of emphysema, namely a combination of the frontal vertical P-vector and a narrow QRS duration, can serve as a quasidiagnostic marker for emphysema, with specificity close to 100%. We postulated that the presence of left ventricular hypertrophy in emphysema may affect the sensitivity of this electrocardiographic criterion given that left ventricular hypertrophy generates prominent left ventricular forces and may increase the QRS duration. Methods We reviewed the electrocardiograms and echocardiograms for 73 patients with emphysema. The patients were divided into two groups based on the presence or absence of echocardiographic evidence of left ventricular hypertrophy. The P-vector, QRS duration, and forced expiratory volume in one second (FEV1) were computed and compared between the two subgroups. Results There was no statistically significant difference in qualitative lung function (FEV1) between the subgroups. There was no statistically significant difference in mean P-vector between the subgroups. The mean QRS duration was significantly longer in patients with left ventricular hypertrophy as compared with those without left ventricular hypertrophy. Conclusion The presence of left ventricular hypertrophy may not affect the sensitivity of the P-vector verticalization when used as a lone criterion for diagnosing emphysema. However, the presence of left ventricular hypertrophy may significantly reduce the sensitivity of the electrocardiographic diagnostic dyad in emphysema, as it causes a widening of the QRS duration. PMID:24293995

Diagnostic electrocardiographic dyad criteria of emphysema in left ventricular hypertrophy.

PubMed

Lanjewar, Swapnil S; Chhabra, Lovely; Chaubey, Vinod K; Joshi, Saurabh; Kulkarni, Ganesh; Kothagundla, Chandrasekhar; Kaul, Sudesh; Spodick, David H

2013-01-01

The electrocardiographic diagnostic dyad of emphysema, namely a combination of the frontal vertical P-vector and a narrow QRS duration, can serve as a quasidiagnostic marker for emphysema, with specificity close to 100%. We postulated that the presence of left ventricular hypertrophy in emphysema may affect the sensitivity of this electrocardiographic criterion given that left ventricular hypertrophy generates prominent left ventricular forces and may increase the QRS duration. We reviewed the electrocardiograms and echocardiograms for 73 patients with emphysema. The patients were divided into two groups based on the presence or absence of echocardiographic evidence of left ventricular hypertrophy. The P-vector, QRS duration, and forced expiratory volume in one second (FEV1) were computed and compared between the two subgroups. There was no statistically significant difference in qualitative lung function (FEV1) between the subgroups. There was no statistically significant difference in mean P-vector between the subgroups. The mean QRS duration was significantly longer in patients with left ventricular hypertrophy as compared with those without left ventricular hypertrophy. The presence of left ventricular hypertrophy may not affect the sensitivity of the P-vector verticalization when used as a lone criterion for diagnosing emphysema. However, the presence of left ventricular hypertrophy may significantly reduce the sensitivity of the electrocardiographic diagnostic dyad in emphysema, as it causes a widening of the QRS duration.

Electrocardiographic abnormalities and arrhythmic risk markers in adult patients with beta thalassemia major.

PubMed

Kolios, Marios; Korantzopoulos, Panagiotis; Vlahos, Antonios P; Kapsali, Eleni; Briasoulis, Evangelos; Goudevenos, John A

2016-10-15

There seems to be a significant arrhythmia burden in β-thalassemia major (TM) patients without overt cardiomyopathy. Apart from conventional electrocardiographic (ECG) and arrhythmic risk markers we studied novel markers of ventricular repolarization and autonomic imbalance both at rest and after exercise testing. We studied 47 adult TM patients without systolic heart failure and 47 age and sex-matched healthy control subjects. The median age of the studied population was 36 [32-43] years, 57% men. Baseline demographic and clinical characteristics were recorded while 12-lead electrocardiograms, 24-hour ECG Holter recordings, and treadmill exercise stress tests were analyzed. TM patients exhibited increased QTc intervals in both 12-lead ECG recordings and in 24-hour Holter recordings. In addition, they had increased indexes of ventricular repolarization heterogeneity such as QT dispersion, and T peak-to-end/QT ratios. Furthermore, TM patients had decreased indexes of heart rate variability while the heart rate recovery after exercise was significantly attenuated compared to controls. Also, they had increased P wave and QRS duration while the QRS fragmentation was very prevalent. Finally, premature atrial extrasystoles and paroxysmal atrial fibrillation episodes were more frequent in TM patients. TM patients with preserved left ventricular systolic function have several ECG abnormalities including alterations in ventricular depolarization and repolarization. Also, cardiac autonomic dysfunction is evident in 24-hour ECG monitoring as well as in the recovery phase after exercise testing. The prognostic value of specific arrhythmic risk indexes in this setting remains to be elucidated. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Analysis Spectrum of ECG Signal and QRS Detection during Running on Treadmill

NASA Astrophysics Data System (ADS)

Agung Suhendra, M.; Ilham R., M.; Simbolon, Artha I.; Faizal A., M.; Munandar, A.

2018-03-01

The heart is an important organ in our metabolism in which it controls circulatory and oxygen. The heart exercise is needed one of them using the treadmill to prevent health. To analysis, it using electrocardiograph (ECG) to investigating and diagnosing anomalies of the heart. In this paper, we would like to analysis ECG signals during running on the treadmill with kinds of speeds. There are two analysis ECG signals i.e. QRS detection and power spectrum density (PSD). The result of PSD showed that subject 3 has highly for all subject and the result of QRS detection using pan Tomkins algorithm that a percentage of failed detection is an approaching to 0 % for all subject.

A novel method for the detection of R-peaks in ECG based on K-Nearest Neighbors and Particle Swarm Optimization

NASA Astrophysics Data System (ADS)

He, Runnan; Wang, Kuanquan; Li, Qince; Yuan, Yongfeng; Zhao, Na; Liu, Yang; Zhang, Henggui

2017-12-01

Cardiovascular diseases are associated with high morbidity and mortality. However, it is still a challenge to diagnose them accurately and efficiently. Electrocardiogram (ECG), a bioelectrical signal of the heart, provides crucial information about the dynamical functions of the heart, playing an important role in cardiac diagnosis. As the QRS complex in ECG is associated with ventricular depolarization, therefore, accurate QRS detection is vital for interpreting ECG features. In this paper, we proposed a real-time, accurate, and effective algorithm for QRS detection. In the algorithm, a proposed preprocessor with a band-pass filter was first applied to remove baseline wander and power-line interference from the signal. After denoising, a method combining K-Nearest Neighbor (KNN) and Particle Swarm Optimization (PSO) was used for accurate QRS detection in ECGs with different morphologies. The proposed algorithm was tested and validated using 48 ECG records from MIT-BIH arrhythmia database (MITDB), achieved a high averaged detection accuracy, sensitivity and positive predictivity of 99.43, 99.69, and 99.72%, respectively, indicating a notable improvement to extant algorithms as reported in literatures.

Multi-channel non-invasive fetal electrocardiography detection using wavelet decomposition

NASA Astrophysics Data System (ADS)

Almeida, Javier; Ruano, Josué; Corredor, Germán.; Romo-Bucheli, David; Navarro-Vargas, José Ricardo; Romero, Eduardo

2017-11-01

Non-invasive fetal electrocardiography (fECG) has attracted the medical community because of the importance of fetal monitoring. However, its implementation in clinical practice is challenging: the fetal signal has a low Signal- to-Noise-Ratio and several signal sources are present in the maternal abdominal electrocardiography (AECG). This paper presents a novel method to detect the fetal signal from a multi-channel maternal AECG. The method begins by applying filters and signal detrending the AECG signals. Afterwards, the maternal QRS complexes are identified and subtracted. The residual signals are used to detect the fetal QRS complex. Intervals of these signals are analyzed by using a wavelet decomposition. The resulting representation feds a previously trained Random Forest (RF) classifier that identifies signal intervals associated to fetal QRS complex. The method was evaluated on a public available dataset: the Physionet2013 challenge. A set of 50 maternal AECG records were used to train the RF classifier. The evaluation was carried out in signals intervals extracted from additional 25 maternal AECG. The proposed method yielded an 83:77% accuracy in the fetal QRS complex classification task.

Signal-Averaged Electrocardiogram in Physically Healthy, Chronic 3,4-Methylenedioxymethamphetamine (MDMA) Users

PubMed Central

Kanneganti, Praveen; Huestis, Marilyn A.; Kolbrich, Erin A.; Robert, Goodwin; Ziegelstein, Roy C.; Gorelick, David A.

2008-01-01

Objectives 3,4-Methylenedioxymethamphetamine (MDMA, ecstasy) use has been associated with cardiac arrhythmias. Markers of ventricular late potentials (VLP), which may be a precursor to malignant ventricular arrhythmias, can be detected by signal-averaged electrocardiography (SA-ECG), but not by standard ECG. Methods We evaluated SA-ECG parameters in 21 physically healthy, recently abstinent MDMA users who also used cannabis (11 males, mean [SD] age 23.3 [4.6] years, 2.8 [2.0] years of use), 18 physically healthy cannabis users (8 males, mean [SD] age 26.6 [7.1] years, 11.2 [5.4] years of use) and 54 non-drug-using controls (21 males, mean [SD] age 28.4 [7.8] years). We analyzed three SA-ECG parameters considered markers of VLPs: duration of filtered QRS complex (fQRS), duration of low amplitude potentials during terminal 40 ms of QRS complex (LAS40), and root mean square voltage during terminal 40 ms of QRS complex (RMS40). Results MDMA users, cannabis users, and non-drug-using controls did not differ significantly from each other in fQRS, LAS40, or RMS40 values or in the proportion of subjects with abnormal SA-ECG parameters. There were significant gender differences among controls, but not among MDMA users. Conclusion These findings suggest that chronic MDMA use is neither quantitatively nor qualitatively associated with a high prevalence of abnormal SA-ECG parameters indicative of VLP markers. PMID:18855243

Data fusion for QRS complex detection in multi-lead electrocardiogram recordings

NASA Astrophysics Data System (ADS)

Ledezma, Carlos A.; Perpiñan, Gilberto; Severeyn, Erika; Altuve, Miguel

2015-12-01

Heart diseases are the main cause of death worldwide. The first step in the diagnose of these diseases is the analysis of the electrocardiographic (ECG) signal. In turn, the ECG analysis begins with the detection of the QRS complex, which is the one with the most energy in the cardiac cycle. Numerous methods have been proposed in the bibliography for QRS complex detection, but few authors have analyzed the possibility of taking advantage of the information redundancy present in multiple ECG leads (simultaneously acquired) to produce accurate QRS detection. In our previous work we presented such an approach, proposing various data fusion techniques to combine the detections made by an algorithm on multiple ECG leads. In this paper we present further studies that show the advantages of this multi-lead detection approach, analyzing how many leads are necessary in order to observe an improvement in the detection performance. A well known QRS detection algorithm was used to test the fusion techniques on the St. Petersburg Institute of Cardiological Technics database. Results show improvement in the detection performance with as little as three leads, but the reliability of these results becomes interesting only after using seven or more leads. Results were evaluated using the detection error rate (DER). The multi-lead detection approach allows an improvement from DER = 3:04% to DER = 1:88%. Further works are to be made in order to improve the detection performance by implementing further fusion steps.

Patients with left bundle branch block and left axis deviation show a specific left ventricular asynchrony pattern: Implications for left ventricular lead placement during CRT implantation.

PubMed

Sciarra, Luigi; Golia, Paolo; Palamà, Zefferino; Scarà, Antonio; De Ruvo, Ermenegildo; Borrelli, Alessio; Martino, Anna Maria; Minati, Monia; Fagagnini, Alessandro; Tota, Claudia; De Luca, Lucia; Grieco, Domenico; Delise, Pietro; Calò, Leonardo

Left bundle branch block (LBBB) and left axis deviation (LAD) patients may have poor response to resynchronization therapy (CRT). We sought to assess if LBBB and LAD patients show a specific pattern of mechanical asynchrony. CRT candidates with non-ischemic cardiomyopathy and LBBB were categorized as having normal QRS axis (within -30° and +90°) or LAD (within -30° and -90°). Patients underwent tissue Doppler imaging (TDI) to measure time interval between onset of QRS complex and peak systolic velocity in ejection period (Q-peak) at basal segments of septal, inferior, lateral and anterior walls, as expression of local timing of mechanical activation. Thirty patients (mean age 70.6years; 19 males) were included. Mean left ventricular ejection fraction was 0.28±0.06. Mean QRS duration was 172.5±13.9ms. Fifteen patients showed LBBB with LAD (QRS duration 173±14; EF 0.27±0.06). The other 15 patients had LBBB with a normal QRS axis (QRS duration 172±14; EF 0.29±0.05). Among patients with LAD, Q-peak interval was significantly longer at the anterior wall in comparison to each other walls (septal 201±46ms, inferior 242±58ms, lateral 267±45ms, anterior 302±50ms; p<0.0001). Conversely, in patients without LAD Q-peak interval was longer at lateral wall, when compared to each other (septal 228±65ms, inferior 250±64ms, lateral 328±98ms, anterior 291±86ms; p<0.0001). Patients with heart failure, presenting LBBB and LAD, show a specific pattern of ventricular asynchrony, with latest activation at anterior wall. This finding could affect target vessel selection during CRT procedures in these patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Peak oxygen uptake, ventilatory efficiency and QRS-duration predict event free survival in patients late after surgical repair of tetralogy of Fallot.

PubMed

Müller, Jan; Hager, Alfred; Diller, Gerhard-Paul; Derrick, Graham; Buys, Roselien; Dubowy, Karl-Otto; Takken, Tim; Orwat, Stefan; Inuzuka, Ryo; Vanhees, Luc; Gatzoulis, Michael; Giardini, Alessandro

2015-10-01

Patients with repaired tetralogy of Fallot (ToF) have an increased long-term risk of cardiovascular morbidity and mortality. Risk stratification in this population is difficult. Initial evidence suggests that cardiopulmonary exercise testing (CPET) may be helpful to risk-stratify patients with repaired ToF. We studied 875 patients after surgical repair for ToF (358 females, age 25.5 ± 11.7 year, range 7-75 years) who underwent CPET between 1999 and 2009. During a mean follow-up of 4.1 ± 2.6 years after CPET, 30 patients (3.4%) died or had sustained ventricular tachycardia (VT). 225 patients (25.7%) had other cardiac related events (emergency admission, surgery, or catheter interventions). On multivariable Cox regression-analysis, %predicted peak oxygen uptake (V˙O2 %) (p=0.001), resting QRS duration (p=0.030) and age (p<0.001) emerged as independent predictors of mortality or sustained VT. Patients with a peak V˙O2 ≤ 65% of predicted and a resting QRS duration ≥ 170 ms had a 11.4-fold risk of death or sustained VT. Ventilatory efficiency expressed as V˙E/V˙CO2 slope (p<0.001), peak V˙O2 % (p=.001), QRS duration (p=.001) and age (p=0.046) independently predicted event free survival. V˙E/V˙CO2 slope ≥ 31.0, peak V˙O2 % ≤ 65% and QRS duration ≥ 170 ms were the cut-off points with best sensitivity and specificity to detect an unfavorable outcome. CPET is an important predictive tool that may assist in the risk stratification of patients with ToF. Subjects with a poor exercise capacity in addition to a prolonged QRS duration have a substantially increased risk for death or sustained ventricular tachycardia, as well as for cardiac-related hospitalizations. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Subtraction electrocardiography: Detection of ischemia-induced ST displacement without the need to identify the J point.

PubMed

Ter Haar, C Cato; Man, Sum-Che; Maan, Arie C; Schalij, Martin J; Swenne, Cees A

2016-01-01

When triaging a patient with acute chest pain at first medical contact, an electrocardiogram (ECG) is routinely made and inspected for signs of myocardial ischemia. The guidelines recommend comparison of the acute and an earlier-made ECG, when available. No concrete recommendations for this comparison exist, neither is known how to handle J-point identification difficulties. Here we present a J-point independent method for such a comparison. After conversion to vectorcardiograms, baseline and acute ischemic ECGs after 3minutes of balloon occlusion during elective PCI were compared in 81 patients of the STAFF III ECG database. Baseline vectorcardiograms were subtracted from ischemic vectorcardiograms using either the QRS onsets or the J points as synchronization instants, yielding vector magnitude difference signals, ΔH. Output variables for the J-point synchronized differences were ΔH at the actual J point and at 20, 40, 60 and 80ms thereafter. Output variables for the onset-QRS synchronized differences were the ΔH at 80, 100, 120, 140 and 160ms after onset QRS. Finally, linear regressions of all combinations of ΔHJ+… versus ΔHQRS+… were made, and the best combination was identified. The highest correlation, 0.93 (p<0.01), was found between ΔH 40ms after the J point and 160ms after the onset of the QRS complex. With a ΔH ischemia threshold of 0.05mV, 66/81 (J-point synchronized differences) and 68/81 (onset-QRS synchronized differences) subjects were above the ischemia threshold, corresponding to sensitivities of 81% and 84%, respectively. Our current study opens an alternative way to detect cardiac ischemia without the need for human expertise for determination of the J point by measuring the difference vector magnitude at 160ms after the onset of the QRS complex. Copyright © 2016 Elsevier Inc. All rights reserved.

Electrical remodeling reflected by QRS and T vector changes following cardiac resynchronization therapy is related to survival in heart failure patients with left bundle branch block.

PubMed

Floré, V; Bartunek, J; Goethals, M; Verstreken, S; Timmermans, W; De Pauw, F; Van Bockstal, K; Vanderheyden, M

2015-01-01

We investigated changes in electrocardiographic spatial QRS and T vectors as markers of electrical remodeling before and after cardiac resynchronization therapy (CRT) and their association with altered outcome. In 41 patients with LBBB, ECGpost was recorded during intrinsic rhythm after interrupting CRT pacing and compared to the pre-implant ECGpre and the ECG during CRT (ECGCRT). Mean spatial angles between QRS and T vectors were determined with the Kors matrix conversion. Left ventricular ejection fraction (LVEF) was determined with nuclear isotope ventriculography before CRT implantation (LVEFpre) and at inclusion (LVEFpost). Following CRT, LVEF improved significantly from 26 ± 10 to 36 ± 14% (p=0.01). Duration of QRSpre (168 ± 15 ms) was not different from QRSpost (166 ± 15 ms). A smaller angle between QRSCRT and Tpost was related to a greater angle between Tpre and Tpost (Pearson's R -0.61 - p<0.001). During follow-up (30 ± 2 months) 9 patients (22%) died. Univariate Cox regression revealed higher mortality in the patients with lower LVEFpost (HR 1.10, p=0.01), a larger angle QRSCRTTpost (HR 1.03, p=0.03), a smaller angle QRSpreQRSpost (HR 0.97, p=0.03) and smaller angle TpreTpost (HR 0.95, p<0.01). After adjusting for LVEFpost, only smaller angle TpreTpost was associated with mortality (HR 0.96, p=0.03). Electrical remodeling can be quantified by measuring the angles between spatial QRS and T vectors before, during and after CRT. In absence of QRS duration changes, more extensive electrical remodeling is associated with a significantly better survival. QRS and T vector changes deserve further investigation to better understand the individual response to CRT. Copyright © 2015 Elsevier Inc. All rights reserved.

Cadmium stress assessment based on the electrocardiogram characteristics of zebra fish (Danio rerio): QRS complex could play an important role.

PubMed

Xing, Na; Ji, Lizhen; Song, Jie; Ma, Jingchun; Li, Shangge; Ren, Zongming; Xu, Fei; Zhu, Jianping

2017-10-01

The electrocardiogram (ECG) of zebra fish (Danio rerio) expresses cardiac features that are similar to humans. Here we use sharp microelectrode measurements to obtain ECG characteristics in adult zebra fish and analyze the effects of cadmium chloride (CdCl 2 ) on the heart. We observe the overall changes of ECG parameters in different treatments (0.1 TU, 0.5 TU and 1.0 TU CdCl 2 ), including P wave, Q wave, R wave, S wave, T wave, PR interval (atrial contraction), QRS complex (ventricular depolarization), ST segment, and QT interval (ventricular repolarization). The trends of the ECG parameters showed some responses to the concentration and exposure time of CdCl 2 , but it was difficult to obtain more information about the useful indicators in water quality assessment depending on tendency analysis alone. A self-organizing map (SOM) showed that P values, R values, and T values were similar; R wave and T wave amplitude were similar; and most important, QRS value was similar to the CdCl 2 stress according to the classified data patterns including CdCl 2 stress (E) and ECG components based on the Ward linkage. It suggested that the duration of QRS complex was related to environmental stress E directly. The specification and evaluation of ECG parameters in Cd 2+ pollution suggested that there is a markedly significant correlation between QRS complex and CdCl 2 stress with the highest r (0.729) and the smallest p (0.002) among all ECG characteristics. In this case, it is concluded that QRS complex can be used as an indicator in the CdCl 2 stress assessment due to the lowest AIC data abased on the linear regression model between the CdCl 2 stress and ECG parameters. Copyright © 2017 Elsevier B.V. All rights reserved.

Depolarization changes during acute myocardial ischemia by evaluation of QRS slopes: standard lead and vectorial approach.

PubMed

Romero, Daniel; Ringborn, Michael; Laguna, Pablo; Pahlm, Olle; Pueyo, Esther

2011-01-01

Diagnosis and risk stratification of patients with acute coronary syndromes can be improved by adding information from the depolarization phase (QRS complex) to the conventionally used ST-T segment changes. In this study, ischemia-induced changes in the main three slopes of the QRS complex, upward ( ℑ(US)) and downward ( ℑ(DS) ) slopes of the R wave as well as the upward ( ℑ(TS)) slope of the terminal S wave, were evaluated as to represent a robust measure of pathological changes within the depolarization phase. From ECG recordings both in a resting state (control recordings) and during percutaneous coronary intervention (PCI)-induced transmural ischemia, we developed a method for quantification of ℑ(US), ℑ(DS), and ℑ(TS) that incorporates dynamic ECG normalization so as to improve the sensitivity in the detection of ischemia-induced changes. The same method was also applied on leads obtained by projection of QRS loops onto their dominant directions. We show that ℑ(US), ℑ(DS), and ℑ(TS) present high stability in the resting state, thus providing a stable reference for ischemia characterization. Maximum relative factors of change ( ℜ(ℑ)) during PCI were found in leads derived from the QRS loop, reaching 10.5 and 13.7 times their normal variations in the control for ℑ(US) and ℑ(DS), respectively. For standard leads, the relative factors of change were 6.01 and 9.31. The ℑ(TS) index presented a similar behavior to that of ℑ(DS). The timing for the occurrence of significant changes in ℑ(US) and ℑ(DS) varied with lead, ranging from 30 s to 2 min after initiation of coronary occlusion. In the present ischemia model, relative ℑ(DS) changes were smaller than ST changes in most leads, however with only modest correlation between the two indices, suggesting they present different information about the ischemic process. We conclude that QRS slopes offer a robust tool for evaluating depolarization changes during myocardial ischemia.

Where is the exact origin of narrow premature ventricular contractions manifesting qR in inferior wall leads?

PubMed

Zheng, Cheng; Li, Jin; Lin, Jia-Xuan; Wang, Lu-Ping; Lin, Jia-Feng

2016-04-04

In recent years, radiofrequency catheter ablation(RFCA) has been established as an effective therapy for idiopathic premature ventricular contractions (PVCs), however, its effect on the narrow PVCs (QRS duration < 130 msec) with qR pattern in inferior leads, may not been fully concluded. Characteristics of 12-lead electrocardiogram (ECG) and electrophysiologic recordings were analyzed in 40 patients with symptomatic PVCs manifesting narrow QRS complex with qR pattern in inferior leads. The procedure of RFCA was performed based on pace mapping and activation mapping. Among the 40 patients with narrow PVCs, complete elimination of PVCs was achieved by RFCA in 35 patients during a median follow-up period of 23 months. Successful ablation was achieved on 19 patients at the sites where earliest Purkinje potentials were recorded in left ventricular anterosuperior septum, thus PVCs arising from left anterior fascicle (LAF) were confirmed, for these PVCs, the QRS morphology were right bundle branch and left posterior fascicle block (RBBB + LPFB) with rightward axis, the average QRS duration 116.07 ± 7.96 ms, R or rsR'in lead V1,with transition zone ahead of lead V1 in precordial leads. Another 16 successful RFCA were achieved by energy delivery at interleaflet triangle(ILT) between right coronary cusp(RCC) and left coronary cusp(LCC) where no Purkinje potentials were recorded, for narrow PVCs arising from the L-RCC ILT, the QRS morphology were similar to the PVCs arising from LAF but much narrower in QRS duration (100.44 ± 3.49 vs. 116.07 ± 7.96 ms, p < 0.05), they were also R or Rs in lead V1 with the transition zone ahead of lead V1. For 5 symptomatic narrow PVCs failed to the procedure of RFCA, their electrocardiographic characteristics showed that the narrowest QRS duration (91.80 ± 6.94 vs. 100.44 ± 3.49, 116.07 ± 7.96 ms, p < 0.05), rs or rS (r/s or r/S≦1) morphology in lead V1 with the precordial transition zone behind lead V3. Most of idiopathic PVCs of narrow QRS duration (<130 msec) with qR pattern in inferior leads can be cured by the procedure of RFCA. On the basis of our study, we proposed that for narrow PVCs presenting qR pattern in inferior leads, when the ablation procedure failed at proximity of LAF within left anterosuperior septum, mapping and ablation in L-RCC ILT can be tried. The present findings can be helpful for planning catheter ablation for narrow PVCs manifesting qR in inferior leads.

Differentiating hypertrophic cardiomyopathy from athlete's heart: An electrocardiographic and echocardiographic approach.

PubMed

Grazioli, Gonzalo; Usín, Domingo; Trucco, Emilce; Sanz, Maria; Montserrat, Silvia; Vidal, Bàrbara; Gutierrez, Josep; Canal, Ramon; Brugada, Josep; Mont, Lluis; Sitges, Marta

2016-01-01

Differential diagnosis of hypertrophic cardiomyopathy (HCM) vs athlete's heart is challenging in individuals with mild-moderate left-ventricular hypertrophy. This study aimed to assess ECG and echocardiographic parameters proposed for the differential diagnosis of HCM. The study included 75 men in three groups: control (n=30), "gray zone" athletes with interventricular septum (IVS) measuring 13-15mm (n=25) and HCM patients with IVS of 13-18mm (n=20). The most significant differences were found in relative septal thickness (RST), calculated as the ratio of 2 x IVS to left ventricle end-diastolic diameter (LV-EDD) (0.37, 0.51, 0.71, respectively; p<0.01) and in spatial QRS-T angle as visually estimated (9.8, 33.6, 66.2, respectively; p<0.01). The capacity for differential HCM diagnosis of each of the 5 criteria was assessed using the area under the curve (AUC), as follows: LV-EDD<54 (0.60), family history (0.61), T-wave inversion (TWI) (0.67), spatial QRS-T angle>45 (0.75) and RST>0.54 (0.92). Pearson correlation between spatial QRS-T angle>45 and TWI was 0.76 (p 0.01). The combination of spatial QRS-T angle>45 and RST>0.54 for diagnosis of HCM had an AUC of 0.79. The best diagnostic criteria for HCM was RST>0.54. The spatial QRS-T angle>45 did not add sensitivity if TWI was present. No additional improvement in differential diagnosis was obtained by combining parameters. Copyright © 2016 Elsevier Inc. All rights reserved.

Left Axis Deviation in Children Without Previously Known Heart Disease.

PubMed

Schneider, Andrew E; Cannon, Bryan C; Johnson, Jonathan N; Ackerman, Michael J; Wackel, Philip L

2018-02-01

Left axis deviation (LAD) discovered in children via electrocardiogram (ECG) is uncommon but can be associated with heart disease (HD). The optimal diagnostic approach in a seemingly healthy child with LAD is unclear. We sought to better stratify which patients with LAD but without previously known HD may warrant additional workup. A retrospective chart review was performed to identify patients ≥1 to <18 years of age with LAD (QRS frontal plane axis 0 to -90) on an ECG between January 2002 and December 2014. Patients with known HD before their initial ECG were excluded. Overall, 296 patients were identified ( n = 181 [61%] male; mean age: 10.8 ± 4.6 years; mean QRS axis: -24 ± 22°). An echocardiogram was performed in 158 (53%) patients, with 24 (15%) having HD. Compared with those with an echocardiogram but without HD ( n = 134), patients with HD had a more negative mean QRS axis (-42 vs -27°; P = .002) and were more likely to have a QRS axis ≤-42° (58% vs 26%; P = .003), ECG chamber enlargement or hypertrophy (38% vs 5%; P < .0001), and abnormal cardiac physical examination findings (75% vs 8%; P < .0001). LAD discovered in isolation in the asymptomatic pediatric patient may not necessitate further cardiovascular investigation. Clinicians should consider obtaining an echocardiogram in patients with LAD and ECG cardiac chamber enlargement or hypertrophy, a QRS axis ≤-42°, and/or the presence of abnormal cardiac physical examination findings. Copyright © 2018 by the American Academy of Pediatrics.

Simultaneous total cavopulmonary connection and cardiac re-synchronisation therapy.

PubMed

Nakanishi, Keisuke; Kawasaki, Shiori; Amano, Atsushi

2017-08-01

We report the simultaneous use of cardiac re-synchronisation therapy and total cavopulmonary connection in a patient with dyssynchrony, wide QRS, and cardiac failure. To our knowledge, this simultaneous approach has not been reported previously. On follow-up, we noted that QRS width and brain natriuretic peptide levels improved. In addition, speckle tracking revealed improved synchronisation of ventricular wall motion.

Coaching as Part of a Pilot Quality Rating Scale Initiative: Challenges to--and Supports for--the Change-Making Process

ERIC Educational Resources Information Center

Ackerman, Debra J.

2008-01-01

Several nonprofit agencies in a large Midwestern city provide assistance to early care and education programs participating in a pilot Quality Rating Scale (QRS) initiative by pairing them with itinerant consultants, who are known as coaches. Despite this assistance, not all programs improve their QRS score. Furthermore, while pilot stakeholders…

Quality Rating and Improvement Systems: A Strategic Movement for Defining Quality

ERIC Educational Resources Information Center

Neugebauer, Roger

2009-01-01

One of the most important trends in the early childhood field is the emergence of quality rating systems (QRS), or quality rating and improvement systems (QRIS), which are designed to assess, improve, and communicate the level of quality of early and school-age care programs. QRS came onto the scene in 1998 when Oklahoma enacted its "Reaching…

On the eccentricity effects on the intraband optical transitions in two dimensional quantum rings with and without donor impurity

NASA Astrophysics Data System (ADS)

Nasri, Djillali

2018-07-01

Using the plane wave expansion in the frame of the effective mass approximation, a straightforward method is presented to calculate the energy levels and the corresponding wavefunctions in a two dimensional GaAs/AlxGa1-xAs eccentric quantum rings (QRs) with and without donor impurity. The transition energy and their related optical absorption coefficients are calculated. The obtained results show that the transition energy between the ground state and the first two excited states and their related optical matrix are strongly influenced by the eccentricity and the donor position. The resonant peaks of the absorption coefficients for electron are blueshifted, while for QRs with an off center impurity the resonant peaks are red or blueshifted depending on the donor positions and eccentricity. In addition, we have found that a small eccentricity acts on the QRs qualitatively as a weak radial electric field. Moreover, an electric field is no longer able to reproduce perfectly the eccentricity effect when the eccentricity becomes relatively strong. Finally, our results are qualitatively similar to those reported in recent works dealing with concentric QRs under a radial electric field.

Month-to-month and year-to-year reproducibility of high frequency QRS ECG signals

NASA Technical Reports Server (NTRS)

Batdorf, Niles J.; Feiveson, Alan H.; Schlegel, Todd T.

2004-01-01

High frequency electrocardiography analyzing the entire QRS complex in the frequency range of 150 to 250 Hz may prove useful in the detection of coronary artery disease, yet the long-term stability of these waveforms has not been fully characterized. Therefore, we prospectively investigated the reproducibility of the root mean squared voltage, kurtosis, and the presence versus absence of reduced amplitude zones in signal averaged 12-lead high frequency QRS recordings acquired in the supine position one month apart in 16 subjects and one year apart in 27 subjects. Reproducibility of root mean squared voltage and kurtosis was excellent over these time intervals in the limb leads, and acceptable in the precordial leads using both the V-lead and CR-lead derivations. The relative error of root mean squared voltage was 12% month-to-month and 16% year-to-year in the serial recordings when averaged over all 12 leads. Reduced amplitude zones were also reproducible up to a rate of 87% and 81%, respectively, for the month-to-month and year-to-year recordings. We conclude that 12-lead high frequency QRS electrocardiograms are sufficiently reproducible for clinical use.

Month-to-Month and Year-to-Year Reproducibility of High Frequency QRS ECG signals

NASA Technical Reports Server (NTRS)

Batdorf, Niles; Feiveson, Alan H.; Schlegel, Todd T.

2006-01-01

High frequency (HF) electrocardiography analyzing the entire QRS complex in the frequency range of 150 to 250 Hz may prove useful in the detection of coronary artery disease, yet the long-term stability of these waveforms has not been fully characterized. We therefore prospectively investigated the reproducibility of the root mean squared (RMS) voltage, kurtosis, and the presence versus absence of reduced amplitude zones (RAzs) in signal averaged 12-lead HF QRS recordings acquired in the supine position one month apart in 16 subjects and one year apart in 27 subjects. Reproducibility of RMS voltage and kurtosis was excellent over these time intervals in the limb leads, and acceptable in the precordial leads using both the V-lead and CR-lead derivations. The relative error of RMS voltage was 12% month-to-month and 16% year-to-year in the serial recordings when averaged over all 12 leads. RAzs were also reproducible at a rate of up to 87% and 8 1 %, respectively, for the month-to-month and year-to-year recordings. We conclude that 12-lead HF QRS electrocardiograms are sufficiently reproducible for clinical use.

Noninvasive fetal QRS detection using an echo state network and dynamic programming.

PubMed

Lukoševičius, Mantas; Marozas, Vaidotas

2014-08-01

We address a classical fetal QRS detection problem from abdominal ECG recordings with a data-driven statistical machine learning approach. Our goal is to have a powerful, yet conceptually clean, solution. There are two novel key components at the heart of our approach: an echo state recurrent neural network that is trained to indicate fetal QRS complexes, and several increasingly sophisticated versions of statistics-based dynamic programming algorithms, which are derived from and rooted in probability theory. We also employ a standard technique for preprocessing and removing maternal ECG complexes from the signals, but do not take this as the main focus of this work. The proposed approach is quite generic and can be extended to other types of signals and annotations. Open-source code is provided.

Noninvasive Diagnosis of Coronary Artery Disease Using 12-Lead High-Frequency Electrocardiograms

NASA Technical Reports Server (NTRS)

Schlegel, Todd T.; Arenare, Brian

2006-01-01

A noninvasive, sensitive method of diagnosing certain pathological conditions of the human heart involves computational processing of digitized electrocardiographic (ECG) signals acquired from a patient at all 12 conventional ECG electrode positions. In the processing, attention is focused on low-amplitude, high-frequency components of those portions of the ECG signals known in the art as QRS complexes. The unique contribution of this method lies in the utilization of signal features and combinations of signal features from various combinations of electrode positions, not reported previously, that have been found to be helpful in diagnosing coronary artery disease and such related pathological conditions as myocardial ischemia, myocardial infarction, and congestive heart failure. The electronic hardware and software used to acquire the QRS complexes and perform some preliminary analyses of their high-frequency components were summarized in Real-Time, High-Frequency QRS Electrocardiograph (MSC- 23154), NASA Tech Briefs, Vol. 27, No. 7 (July 2003), pp. 26-28. To recapitulate, signals from standard electrocardiograph electrodes are preamplified, then digitized at a sampling rate of 1,000 Hz, then analyzed by the software that detects R waves and QRS complexes and analyzes them from several perspectives. The software includes provisions for averaging signals over multiple beats and for special-purpose nonrecursive digital filters with specific low- and high-frequency cutoffs. These filters, applied to the averaged signal, effect a band-pass operation in the frequency range from 150 to 250 Hz. The output of the bandpass filter is the desired high-frequency QRS signal. Further processing is then performed in real time to obtain the beat-to-beat root mean square (RMS) voltage amplitude of the filtered signal, certain variations of the RMS voltage, and such standard measures as the heart rate and R-R interval at any given time. A key signal feature analyzed in the present method is the presence versus the absence of reduced-amplitude zones (RAZs). In terms that must be simplified for the sake of brevity, an RAZ comprises several cycles of a high-frequency QRS signal during which the amplitude of the high-frequency oscillation in a portion of the signal is abnormally low (see figure). A given signal sample exhibiting an interval of reduced amplitude may or may not be classified as an RAZ, depending on quantitative criteria regarding peaks and troughs within the reduced-amplitude portion of the high-frequency QRS signal. This analysis is performed in all 12 leads in real time.

Validation of criteria for selective his bundle and para-hisian permanent pacing.

PubMed

Cantù, F; De Filippo, P; Cardano, P; De Luca, A; Gavazzi, A

2006-12-01

His Bundle (HB) pacing is a valid alternative to right ventricular pacing for patients with preserved His-ventricle conduction who are candidates for permanent stimulation. Permanent pacing in the HB area enables Selective HB pacing (SHBP) or para-Hisian pacing (PHP) to be achieved. The aim of our study was to draw up a set of easy criteria to differentiate and validate the two kinds of stimulations according to the pacing output and the ECG/EKG signals. From February to July 2005, 17 patients eligible for a pacemaker (PM) procedure underwent implantation with the Medtronic SelectSecure lead (Medtronic, Minneapolis, MN, USA) screwed into the HB area.SHBP was defined when the intrinsic QRS was equal, in both duration and morphology, to the paced QRS, the His-Ventricular (H-V) interval was equal to Pace-Ventricular interval (Vp-V) and, at low output, only the HB was captured, while increasing the output resulted in both the HB and right ventricular (RV) being captured (widening of QRS at high output). Conversely, PHP was defined when the intrinsic QRS differed from the paced one, either in morphology or in duration and, at high output, both the RV and HB were captured (non-SHBP), while decreasing the output resulted in losing HB capture (widening of QRS at low output). According to these criteria, SHBP was achieved in 11 patients, while in the remaining 6, PHP was obtained. No adverse events were reported. The above criteria enabled SHBP and PHP to be validated easily and clearly. A longer follow-up will be needed in order to ascertain whether the clinical outcome of these two approaches differs.

Are the QRS duration and ST depression cut-points from the Seattle criteria too conservative?

PubMed

Dunn, Tim; Abdelfattah, Ramy; Aggarwal, Sonya; Pickham, David; Hadley, David; Froelicher, Victor

2015-01-01

Screening athletes with ECGs is aimed at identifying "at-risk" individuals who may have a cardiac condition predisposing them to sudden cardiac death. The Seattle criteria highlight QRS duration greater than 140 ms and ST segment depression in two or more leads greater than 50 μV as two abnormal ECG patterns associated with sudden cardiac death. High school, college, and professional athletes underwent 12 lead ECGs as part of routine pre-participation physicals. Prevalence of prolonged QRS duration was measured using cut-points of 120, 125, 130, and 140 ms. ST segment depression was measured in all leads except leads III, aVR, and V1 with cut-points of 25 μV and 50 μV. Between June 2010 and November 2013, 1595 participants including 297 (167 male, mean age 16.2) high school athletes, 1016 (541 male, mean age 18.8) college athletes, and 282 (mean age 26.6) male professional athletes underwent screening with an ECG. Only 3 athletes (0.2%) had a QRS duration greater than 125 ms. ST segment depression in two or more leads greater than 50 μV was uncommon (0.8%), while the prevalence of ST segment depression in two or more leads increased to 4.5% with a cut-point of 25 μV. Changing the QRS duration cut-point to 125 ms would increase the sensitivity of the screening ECG, without a significant increase in false-positives. However, changing the ST segment depression cut-point to 25 μV would lead to a significant increase in false-positives and would therefore not be justified. Copyright © 2015 Elsevier Inc. All rights reserved.

Cardiac-resynchronization therapy in heart failure with a narrow QRS complex.

PubMed

Ruschitzka, Frank; Abraham, William T; Singh, Jagmeet P; Bax, Jeroen J; Borer, Jeffrey S; Brugada, Josep; Dickstein, Kenneth; Ford, Ian; Gorcsan, John; Gras, Daniel; Krum, Henry; Sogaard, Peter; Holzmeister, Johannes

2013-10-10

Cardiac-resynchronization therapy (CRT) reduces morbidity and mortality in chronic systolic heart failure with a wide QRS complex. Mechanical dyssynchrony also occurs in patients with a narrow QRS complex, which suggests the potential usefulness of CRT in such patients. We conducted a randomized trial involving 115 centers to evaluate the effect of CRT in patients with New York Heart Association class III or IV heart failure, a left ventricular ejection fraction of 35% or less, a QRS duration of less than 130 msec, and echocardiographic evidence of left ventricular dyssynchrony. All patients underwent device implantation and were randomly assigned to have CRT capability turned on or off. The primary efficacy outcome was the composite of death from any cause or first hospitalization for worsening heart failure. On March 13, 2013, the study was stopped for futility on the recommendation of the data and safety monitoring board. At study closure, the 809 patients who had undergone randomization had been followed for a mean of 19.4 months. The primary outcome occurred in 116 of 404 patients in the CRT group, as compared with 102 of 405 in the control group (28.7% vs. 25.2%; hazard ratio, 1.20; 95% confidence interval [CI], 0.92 to 1.57; P=0.15). There were 45 deaths in the CRT group and 26 in the control group (11.1% vs. 6.4%; hazard ratio, 1.81; 95% CI, 1.11 to 2.93; P=0.02). In patients with systolic heart failure and a QRS duration of less than 130 msec, CRT does not reduce the rate of death or hospitalization for heart failure and may increase mortality. (Funded by Biotronik and GE Healthcare; EchoCRT ClinicalTrials.gov number, NCT00683696.).

Advanced ECG in 2016: is there more than just a tracing?

PubMed

Reichlin, Tobias; Abächerli, Roger; Twerenbold, Raphael; Kühne, Michael; Schaer, Beat; Müller, Christian; Sticherling, Christian; Osswald, Stefan

2016-01-01

The 12-lead electrocardiogram (ECG) is the most frequently used technology in clinical cardiology. It is critical for evidence-based management of patients with most cardiovascular conditions, including patients with acute myocardial infarction, suspected chronic cardiac ischaemia, cardiac arrhythmias, heart failure and implantable cardiac devices. In contrast to many other techniques in cardiology, the ECG is simple, small, mobile, universally available and cheap, and therefore particularly attractive. Standard ECG interpretation mainly relies on direct visual assessment. The progress in biomedical computing and signal processing, and the available computational power offer fascinating new options for ECG analysis relevant to all fields of cardiology. Several digital ECG markers and advanced ECG technologies have shown promise in preliminary studies. This article reviews promising novel surface ECG technologies in three different fields. (1) For the detection of myocardial ischaemia and infarction, QRS morphology feature analysis, the analysis of high frequency QRS components (HF-QRS) and methods using vectorcardiography as well as ECG imaging are discussed. (2) For the identification and management of patients with cardiac arrhythmias, methods of advanced P-wave analysis are discussed and the concept of ECG imaging for noninvasive localisation of cardiac arrhythmias is presented. (3) For risk stratification of sudden cardiac death and the selection of patients for medical device therapy, several novel markers including an automated QRS-score for scar quantification, the QRS-T angle or the T-wave peak-to-end-interval are discussed. Despite the existing preliminary data, none of the advanced ECG markers and technologies has yet accomplished the transition into clinical practice. Further refinement of these technologies and broader validation in large unselected patient cohorts are the critical next step needed to facilitate translation of advanced ECG technologies into clinical cardiology.

Une tachycardie à QRS large mal tolérée chez un nourrisson

PubMed Central

Affangla, Désiré Alain; Leye, Mohamed; Simo, Angèle Wabo; D’Almeida, Franck; Sarr, Thérèse Yandé; Phiri, Adamson; Kane, Adama

2017-01-01

Les tachycardies à QRS large mal tolérées du nourrisson posent le problème de leur diagnostic et de la prise en charge en urgence. Nous rapportons un cas de tachycardie à QRS large chez un nourrisson de 35 jours reçu pour détresse cardio-circulatoire. Le cœur était morphologiquement normal à l’échographie cardiaque Doppler. Un traitement par une dose charge d’Amiodarone n’a pas permis de réduire cette tachycardie. Un retour en rythme sinusal a été obtenu après cardioversion par un défibrillateur externe semi-automatique type Lifeline. Un traitement d’entretien par Amiodarone per os est institué et le patient est en rythme sinusal à 03 mois. PMID:28904685

Sleep Detriments Associated With Quick Returns in Rotating Shift Work: A Diary Study.

PubMed

Vedaa, Øystein; Mørland, Erik; Larsen, Marit; Harris, Anette; Erevik, Eilin; Sivertsen, Børge; Bjorvatn, Bjørn; Waage, Siri; Pallesen, Ståle

2017-06-01

We aimed to compared sleep characteristics associated with quick returns (QRs, <11 hours between shift intervals) with those associated with other common shift transitions. Sixty-seven nurses completed a 2-week work and sleep diary (94.0% female, mean age 47.7 years). A multilevel fixed effects model was used to examine the sleep in QRs compared with two consecutive night shifts, two consecutive evening shifts, and two consecutive day shifts, respectively. None of the other shift transitions studied encumbered as many detriments as QRs, which included short sleep duration (5.6 hours), slightly prolonged sleep onset latency, more abrupt ending of main sleep period, increased sleepiness, and higher level of perceived stress on the following shift. The study emphasizes the need for sufficient time for rest and recuperation between shifts.

A real time QRS detection using delay-coordinate mapping for the microcontroller implementation.

PubMed

Lee, Jeong-Whan; Kim, Kyeong-Seop; Lee, Bongsoo; Lee, Byungchae; Lee, Myoung-Ho

2002-01-01

In this article, we propose a new algorithm using the characteristics of reconstructed phase portraits by delay-coordinate mapping utilizing lag rotundity for a real-time detection of QRS complexes in ECG signals. In reconstructing phase portrait the mapping parameters, time delay, and mapping dimension play important roles in shaping of portraits drawn in a new dimensional space. Experimentally, the optimal mapping time delay for detection of QRS complexes turned out to be 20 ms. To explore the meaning of this time delay and the proper mapping dimension, we applied a fill factor, mutual information, and autocorrelation function algorithm that were generally used to analyze the chaotic characteristics of sampled signals. From these results, we could find the fact that the performance of our proposed algorithms relied mainly on the geometrical property such as an area of the reconstructed phase portrait. For the real application, we applied our algorithm for designing a small cardiac event recorder. This system was to record patients' ECG and R-R intervals for 1 h to investigate HRV characteristics of the patients who had vasovagal syncope symptom and for the evaluation, we implemented our algorithm in C language and applied to MIT/BIH arrhythmia database of 48 subjects. Our proposed algorithm achieved a 99.58% detection rate of QRS complexes.

Quick detection of QRS complexes and R-waves using a wavelet transform and K-means clustering.

PubMed

Xia, Yong; Han, Junze; Wang, Kuanquan

2015-01-01

Based on the idea of telemedicine, 24-hour uninterrupted monitoring on electrocardiograms (ECG) has started to be implemented. To create an intelligent ECG monitoring system, an efficient and quick detection algorithm for the characteristic waveforms is needed. This paper aims to give a quick and effective method for detecting QRS-complexes and R-waves in ECGs. The real ECG signal from the MIT-BIH Arrhythmia Database is used for the performance evaluation. The method proposed combined a wavelet transform and the K-means clustering algorithm. A wavelet transform is adopted in the data analysis and preprocessing. Then, based on the slope information of the filtered data, a segmented K-means clustering method is adopted to detect the QRS region. Detection of the R-peak is based on comparing the local amplitudes in each QRS region, which is different from other approaches, and the time cost of R-wave detection is reduced. Of the tested 8 records (total 18201 beats) from the MIT-BIH Arrhythmia Database, an average R-peak detection sensitivity of 99.72 and a positive predictive value of 99.80% are gained; the average time consumed detecting a 30-min original signal is 5.78s, which is competitive with other methods.

Quantitative assessment of 12-lead ECG synthesis using CAVIAR.

PubMed

Scherer, J A; Rubel, P; Fayn, J; Willems, J L

1992-01-01

The objective of this study is to assess the performance of patient-specific segment-specific (PSSS) synthesis in QRST complexes using CAVIAR, a new method of the serial comparison for electrocardiograms and vectorcardiograms. A collection of 250 multi-lead recordings from the Common Standards for Quantitative Electrocardiography (CSE) diagnostic pilot study is employed. QRS and ST-T segments are independently synthesized using the PSSS algorithm so that the mean-squared error between the original and estimated waveforms is minimized. CAVIAR compares the recorded and synthesized QRS and ST-T segments and calculates the mean-quadratic deviation as a measure of error. The results of this study indicate that estimated QRS complexes are good representatives of their recorded counterparts, and the integrity of the spatial information is maintained by the PSSS synthesis process. Analysis of the ST-T segments suggests that the deviations between recorded and synthesized waveforms are considerably greater than those associated with the QRS complexes. The poorer performance of the ST-T segments is attributed to magnitude normalization of the spatial loops, low-voltage passages, and noise interference. Using the mean-quadratic deviation and CAVIAR as methods of performance assessment, this study indicates that the PSSS-synthesis algorithm accurately maintains the signal information within the 12-lead electrocardiogram.

Molecular Dynamics Simulations of a Cyclic DP-240 Amylose Fragment in a Periodic Cell: Glass Transition Temperature and Water Diffusion

USDA-ARS?s Scientific Manuscript database

Molecular dynamics simulations using AMB06C, an in-house carbohydrate force field, (NPT ensembles, 1atm) were carried out on a periodic cell that contained a cyclic-DP-240 amylose fragment and TIP3P water molecules. Molecular conformation and movement of the amylose fragment and water molecules at ...

Wide QRS tachycardia: what is the rhythm?

PubMed

Rosman, Jonathan; Tawil, Joseph; Hanon, Sam; Schweitzer, Paul

2006-10-01

We report a case of an elderly man who presented to the emergency room complaining of palpitations. Electrocardiogram revealed wide QRS tachycardia with a narrow beat within the tachycardia. Most commonly, a narrow complex beat during a wide complex tachycardia suggests a capture or fusion beat in the setting of ventricular tachycardia. However, there are situations where supraventricular tachycardia can also manifest this way. In our patient a pacemaker interrogation clarified the diagnosis.

CdSe/CdS semiconductor quantum rods as robust fluorescent probes for paraffin-embedded tissue imaging.

PubMed

Zacheo, Antonella; Quarta, Alessandra; Mangoni, Antonella; Pompa, Pier Paolo; Mastria, Rosanna; Capogrossi, Maurizio C; Rinaldi, Ross; Pellegrino, Teresa

2011-09-01

Immunofluorescence techniques on formalin fixed paraffin-embedded sections allow for the evaluation of the expression and spatial distribution of specific markers in patient tissue specimens or for monitoring the fate of labeled cells after in vivo injection. This technique suffers however from the auto-fluorescence background signal of the embedded tissue that eventually confounds the analysis. Here we show that rod-like semiconductor nanocrystals (QRs), intramuscularly injected in living mice, could be clearly detected by confocal microscopy in formalin fixed paraffin-embedded tissue sections. Despite the low amount of QRs amount injected (25 picomoles), these were clearly visible after 24 h in the muscle sections and their fluorescence signal was stronger than that of CdSe/ZnS quantum dots (QDs) similarly functionalized and in the case of QRs only, the signal lasted even after 21 days after the injection. © 2011 IEEE

Electrocardiogram voltage discordance: Interpretation of low QRS voltage only in the precordial leads.

PubMed

Kim, Diana H; Verdino, Ralph J

To define clinical correlates of low voltage isolated to precordial leads on the surface electrocardiogram (ECG). Low voltage (V) on the ECG is defined as QRS V<5mm in all limb leads and <10mm in all precordial leads. The diagnostic use of ECGs with low voltage isolated to the precordial leads with normal limb lead voltages is unclear. Twelve-lead ECGs with QRS V>5mm in one or more limb leads and <10mm in all precordial leads were collected. Associated clinical conditions were determined from clinical data, echocardiograms, and chest radiographs. Low precordial voltage was found in 256 of 150,000 ECGs (~0.2%). 50.4% of patients had discordant ECGs that correlated with classic etiologies, with a higher incidence of LV dilation in those with classic etiologies than those without. Low precordial voltage is associated with classic etiologies and LV dilation. Copyright © 2017 Elsevier Inc. All rights reserved.

Real-time, high frequency QRS electrocardiograph

NASA Technical Reports Server (NTRS)

Schlegel, Todd T. (Inventor); DePalma, Jude L. (Inventor); Moradi, Saeed (Inventor)

2006-01-01

Real time cardiac electrical data are received from a patient, manipulated to determine various useful aspects of the ECG signal, and displayed in real time in a useful form on a computer screen or monitor. The monitor displays the high frequency data from the QRS complex in units of microvolts, juxtaposed with a display of conventional ECG data in units of millivolts or microvolts. The high frequency data are analyzed for their root mean square (RMS) voltage values and the discrete RMS values and related parameters are displayed in real time. The high frequency data from the QRS complex are analyzed with imbedded algorithms to determine the presence or absence of reduced amplitude zones, referred to herein as RAZs. RAZs are displayed as go, no-go signals on the computer monitor. The RMS and related values of the high frequency components are displayed as time varying signals, and the presence or absence of RAZs may be similarly displayed over time.

Origins location of the outflow tract ventricular arrhythmias exhibiting qrS pattern or QS pattern with a notch on the descending limb in lead V1.

PubMed

Lin, Cong; Zheng, Cheng; Zhou, De-Pu; Li, Xiao-Wei; Wu, Shu-Jie; Lin, Jia-Feng

2017-05-15

Ventricular outflow tract(VOT) ventricular arrhythmias(VAs) presenting qrS pattern or QS pattern with a notch on the descending limb in lead V1 were consistently thought of arising from the commissure between left and right coronary cusp (L-RCC) by previous studies. However, we found they could originate from other anatomic structures in VOT. This study aimed to investigate the exact origin of this kind VAs. Forty-nine patients of VOT premature ventricular contrations/ventricular tachycardia(PVCs/VT) with lead V1 presenting qrS pattern or QS pattern with a notch on the descending limb undergoing successful radiofrequency catheter ablation(RFCA) in our center were analyzed. 12-lead electrocardiogram(ECG) of these PVCs/VT were summarized. Among these PVCs/VT, 37 cases exhibited qrS morphology in lead V1, 12 cases presented QS pattern with a notch on the descending limb in the same lead. Based on the successful ablation sites, these PVCs/VT were divided into 2 groups: (1)Right ventricular outflow tract(RVOT) group (26 cases), and (2) Left ventricular outflow tract (LVOT) group(23 cases, 4 cases originating from the left coronary cusp(LCC), 2 from the right coronary cusp(RCC), 16 from the L-RCC, 1 from the area inferior to LCC(ILCC)). The ECG characteristics of each PVCs/VT were analyzed. Among these PVCs/VT, applying the precordial transitional zone index(TZ index) < 0 to predict LVOT origin was demonstrated with sensitivity of 95.65%, specificity of 96.15%, positive predicting value(PPV) of 95.65% and negative predicting value(NPV) of 96.15%. In LVOT group, further applying the r, R, m,or Rs morphology in lead I to predict L-RCC and RCC origin was demonstrated with sensitivity of 94.44%, specificity of 60.00%, PPV of 89.47% and NPV of 75.00%. Ventricular outflow tract PVCs/VT with lead V1 presenting qrS pattern or QS pattern with a notch on descending limb not only arising from L-RCC, but also RVOT, LCC, RCC and ILCC. Combining TZ index and QRS morphology in lead I to predict origin site of these kind VAs is a convenient, simple and reliable method and facilitates the RFCA procedure.

Effect of isospin diffusion on the production of neutron-rich nuclei in multinucleon transfer reactions

NASA Astrophysics Data System (ADS)

Niu, Fei; Chen, Peng-Hui; Guo, Ya-Fei; Ma, Chun-Wang; Feng, Zhao-Qing

2018-03-01

The isospin dissipation dynamics in multinucleon transfer reactions has been investigated within the dinuclear system model. Production cross sections of neutron-rich isotopes around projectile-like and target-like fragments are estimated in collisions of Ni,6458+208Pb and 78.86,91Kr +198Pt near Coulomb barrier energies. The isospin diffusion in the nucleon transfer process is coupled to the dissipation of relative motion energy and angular momentum of colliding system. The available data of projectile-like fragments via multinucleon transfer reactions are nicely reproduced. It is found that the light projectile-like fragments are produced in the neutron-rich region because of the isospin equilibrium in two colliding nuclei. However, the heavy target-like fragments tend to be formed on the neutron-poor side above the β -stability line. The neutron-rich projectiles move the maximal yields of heavy nuclei to the neutron-rich domain and are available for producing the heavy exotic isotopes, in particular around the neutron shell closure of N =126 .

Quantitative spatiotemporal analysis of antibody fragment diffusion and endocytic consumption in tumor spheroids.

PubMed

Thurber, Greg M; Wittrup, K Dane

2008-05-01

Antibody-based cancer treatment depends upon distribution of the targeting macromolecule throughout tumor tissue, and spatial heterogeneity could significantly limit efficacy in many cases. Antibody distribution in tumor tissue is a function of drug dosage, antigen concentration, binding affinity, antigen internalization, drug extravasation from blood vessels, diffusion in the tumor extracellular matrix, and systemic clearance rates. We have isolated the effects of a subset of these variables by live-cell microscopic imaging of single-chain antibody fragments against carcinoembryonic antigen in LS174T tumor spheroids. The measured rates of scFv penetration and retention were compared with theoretical predictions based on simple scaling criteria. The theory predicts that antibody dose must be large enough to drive a sufficient diffusive flux of antibody to overcome cellular internalization, and exposure time must be long enough to allow penetration to the spheroid center. The experimental results in spheroids are quantitatively consistent with these predictions. Therefore, simple scaling criteria can be applied to accurately predict antibody and antibody fragment penetration distance in tumor tissue.

Quantitative Spatiotemporal Analysis of Antibody Fragment Diffusion and Endocytic Consumption in Tumor Spheroids

PubMed Central

Thurber, Greg M.; Wittrup, K. Dane

2010-01-01

Antibody-based cancer treatment depends upon distribution of the targeting macromolecule throughout tumor tissue, and spatial heterogeneity could significantly limit efficacy in many cases. Antibody distribution in tumor tissue is a function of drug dosage, antigen concentration, binding affinity, antigen internalization, drug extravasation from blood vessels, diffusion in the tumor extracellular matrix, and systemic clearance rates. We have isolated the effects of a subset of these variables by live-cell microscopic imaging of single-chain antibody fragments against carcinoembryonic antigen in LS174T tumor spheroids. The measured rates of scFv penetration and retention were compared with theoretical predictions based on simple scaling criteria. The theory predicts that antibody dose must be large enough to drive a sufficient diffusive flux of antibody to overcome cellular internalization, and exposure time must be long enough to allow penetration to the spheroid center. The experimental results in spheroids are quantitatively consistent with these predictions. Therefore, simple scaling criteria can be applied to accurately predict antibody and antibody fragment penetration distance in tumor tissue. PMID:18451160

Atrial Premature Depolarization-Induced Changes in QRS and T Wave Morphology on Resting Electrocardiograms in Horses.

PubMed

Broux, B; De Clercq, D; Decloedt, A; Van Der Vekens, N; Verheyen, T; Ven, S; Pardon, B; van Loon, G

2016-07-01

The electrocardiographic differentiation between atrial (APDs) and ventricular (VPDs) premature depolarizations is important. P wave prematurity and normal QRS and T wave morphology generally are used as discriminating criteria for APDs. The aim of this study was to determine whether P, Q, R, S, and T wave amplitude, PQ interval, QRS and P wave duration and P and T wave morphology differ between APDs and sinus beats. To determine the relationship between the RR coupling interval and the change in S wave amplitude between sinus beats and APDs. Case-control study. From a modified base-apex configuration of 30 horses with APDs at rest, sinus beat and APD associated preceding RR interval, P, PQ and QRS duration and P, R, S, and T wave amplitudes were measured. Linear mixed models and logistic regression were used to determine the effect of APDs on the ECG variables studied. In comparison to sinus beats, APDs were associated with a significant (P < .001) change in P amplitude (-0.03 ± 0.01 mV) and increase in S (0.20 ± 0.02 mV) and T (0.08 ± 0.03 mV) amplitude. PQ (-20.3 ± 5.2 ms) and RR (-519 ± 14 ms) interval and P duration (-21.1 ± 3.0 ms) decreased (P < .001). APDs were significantly associated with a singular positive P wave (OR: 11.0, P < .001) and were more likely to have a monophasic positive T wave (OR: 9.2, P < .001). A smaller RR coupling interval was associated with an increased relative difference in S amplitude (P < .01). Atrial premature depolarizations may lead to changes in QRS and T wave morphology. Knowledge of these changes is important to avoid interpreting certain APDs as VPDs. Copyright © 2016 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

Effect of study design on the reported effect of cardiac resynchronization therapy (CRT) on quantitative physiological measures: stratified meta-analysis in narrow-QRS heart failure and implications for planning future studies.

PubMed

Jabbour, Richard J; Shun-Shin, Matthew J; Finegold, Judith A; Afzal Sohaib, S M; Cook, Christopher; Nijjer, Sukhjinder S; Whinnett, Zachary I; Manisty, Charlotte H; Brugada, Josep; Francis, Darrel P

2015-01-06

Biventricular pacing (CRT) shows clear benefits in heart failure with wide QRS, but results in narrow QRS have appeared conflicting. We tested the hypothesis that study design might have influenced findings. We identified all reports of CRT-P/D therapy in subjects with narrow QRS reporting effects on continuous physiological variables. Twelve studies (2074 patients) met these criteria. Studies were stratified by presence of bias-resistance steps: the presence of a randomized control arm over a single arm, and blinded outcome measurement. Change in each endpoint was quantified using a standardized effect size (Cohen's d). We conducted separate meta-analyses for each variable in turn, stratified by trial quality. In non-randomized, non-blinded studies, the majority of variables (10 of 12, 83%) showed significant improvement, ranging from a standardized mean effect size of +1.57 (95%CI +0.43 to +2.7) for ejection fraction to +2.87 (+1.78 to +3.95) for NYHA class. In the randomized, non-blinded study, only 3 out of 6 variables (50%) showed improvement. For the randomized blinded studies, 0 out of 9 variables (0%) showed benefit, ranging from -0.04 (-0.31 to +0.22) for ejection fraction to -0.1 (-0.73 to +0.53) for 6-minute walk test. Differences in degrees of resistance to bias, rather than choice of endpoint, explain the variation between studies of CRT in narrow-QRS heart failure addressing physiological variables. When bias-resistance features are implemented, it becomes clear that these patients do not improve in any tested physiological variable. Guidance from studies without careful planning to resist bias may be far less useful than commonly perceived. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

[Basic mechanisms of QRS voltage changes on ECG of healthy subjects during the exercise test].

PubMed

Saltykova, M M

2015-01-01

Electrocardiography is the most commonly used technique for detection stress-induced myocardial ischemia. However, the sensitivity of ECG-criteria is not high. One of the major problem is the difficulty in differentiating ECG changes caused by various factors. The aim of this study was to evaluate the dependence of the QRS voltage changes during exercise on parameters of central hemodynamics, gender particularities and to reveal mechanisms causing these changes. To eliminate the effect of changes in cardiomyocytes transmembrane potentials under the influence of the neurotransmitters of the autonomic nervous system during stepwise increasing exercises and/or due to a lack of ATP results from inadequate myocardial blood flow only healthy subjects not older than 35 years were included in the study (7 men and 7 women) and only periods of ventricular depolarization (QRS complex on the ECG) were included in the analysis. We compared the changes of QRS waves during exercise sessions with two upper and one lower limbs in both men and women. The exercise load was twice bigger in exercise with one leg relative to exercise with two arms. Responses of heart rate and systolic arterial pressure were similar. Amplitude of S-wave in left chest leads significantly increased in both sessions without significant difference between augmentations in the sessions and in groups of men and women. Significant relationship between the S wave augmentation and the peak systolic arterial pressure were revealed. Furthermore, the QRS changes during the exercise with vertical and a horizontal torso position were compared to assess the impact of diastolic arterial pressure and displacement of the diaphragm and heart rotation due to increase of abdominal pressure during the last steps of exercise. The obtained results allow us to exclude the impact of the heart position and size changes, as well as the exercise load on S-wave changes and make a conclusion about the dependence of this parameter on the value of systolic blood pressure.

A coagulation-fragmentation model for the turbulent growth and destruction of preplanetesimals

NASA Astrophysics Data System (ADS)

Johansen, A.; Brauer, F.; Dullemond, C.; Klahr, H.; Henning, T.

2008-08-01

To treat the problem of growing protoplanetary disc solids across the meter barrier, we consider a very simplified two-component coagulation-fragmentation model that consists of macroscopic boulders and smaller dust grains, the latter being the result of catastrophic collisions between the boulders. Boulders in turn increase their radii by sweeping up the dust fragments. An analytical solution of the dynamical equations predicts that growth by coagulation-fragmentation can be efficient and allow agglomeration of 10-m-sized objects within the time-scale of the radial drift. These results are supported by computer simulations of the motion of boulders and fragments in 3-D time-dependent magnetorotational turbulence. However allowing the fragments to diffuse freely out of the sedimentary layer of boulders drastically reduces the density of both boulders and fragments in the mid-plane, and thus also the growth of the boulder radius. The reason is that the turbulent diffusion time-scale is so much shorter than the collisional time-scale that dust fragments leak out of the mid-plane layer before they can be swept up by the boulders there. Our conclusion that coagulation-fragmentation is not an efficient way to grow across the meter barrier in fully turbulent protoplanetary discs confirms recent results by Brauer, Dullemond, & Henning who solved the coagulation equation in a parameterised turbulence model with collisional fragmentation, cratering, radial drift, and a range of particle sizes. We find that a relatively small population of boulders in a sedimentary mid-plane layer can populate the entire vertical extent of the disc with small grains and that these grains are not first generation dust, but have been through several agglomeration-destruction cycles during the simulations.

Spectral analysis of epicardial 60-lead electrograms in dogs with 4-week-old myocardial infarction.

PubMed

Hosoya, Y; Ikeda, K; Komatsu, T; Yamaki, M; Kubota, I

2001-01-01

There were few studies on the spectral analysis of multiple-lead epicardial electrograms in chronic myocardial infarction. Spectral analysis of multi-lead epicardial electrograms was performed in 6 sham-operated dogs (N group) and 8 dogs with 4-week-old myocardial infarction (MI group). Four weeks after the ligation of left anterior descending coronary artery, fast Fourier transform was performed on 60-lead epicardial electrograms, and then inverse transform was performed on 5 frequency ranges from 0 to 250 Hz. From the QRS onset to QRS offset, the time integration of unsigned value of reconstructed waveform was calculated and displayed as AQRS maps. On 0-25 Hz AQRS map, there was no significant difference between the 2 groups. In the frequency ranges of 25-250 Hz, MI group had significantly smaller AQRS values than N group solely in the infarct zone. It was shown that high frequency potentials (25-250 Hz) within QRS complex were reduced in the infarct zone.

Prognostic significance of inverse spatial QRS-T angle circadian pattern in myocardial infarction survivors.

PubMed

Giannopoulos, Georgios; Dilaveris, Polychronis; Batchvarov, Velislav; Synetos, Andreas; Hnatkova, Katerina; Gatzoulis, Konstantinos; Malik, Marek; Stefanadis, Christodoulos

2009-01-01

We investigated the predictive value of the spatial QRS-T angle (QRSTA) circadian variation in myocardial infarction (MI) patients. Analyzing 24-hour recordings (SEER MC, GE Marquette) from 151 MI patients (age 63 +/- 12.7), the QRSTA was computed in derived XYZ leads. QRS-T angle values were compared between daytime and night time. The end point was cardiac death or life-threatening ventricular arrhythmia in 1 year. Overall, QRSTA was slightly higher during the day vs. the night (91 degrees vs. 87 degrees, P = .005). However, 33.8% of the patients showed an inverse diurnal QRSTA variation (higher values at night), which was correlated to the outcome (P = .001, odds ratio 6.7). In multivariate analysis, after entering all factors exhibiting univariate trend towards significance, inverse QRSTA circadian pattern remained significant (P = .036). Inverse QRSTA circadian pattern was found to be associated with adverse outcome (22.4%) in MI patients, whereas a normal pattern was associated (96%) with a favorable outcome.

Real-time, high frequency QRS electrocardiograph with reduced amplitude zone detection

NASA Technical Reports Server (NTRS)

Schlegel, Todd T. (Inventor); DePalma, Jude L. (Inventor); Moradi, Saeed (Inventor)

2009-01-01

Real time cardiac electrical data are received from a patient, manipulated to determine various useful aspects of the ECG signal, and displayed in real time in a useful form on a computer screen or monitor. The monitor displays the high frequency data from the QRS complex in units of microvolts, juxtaposed with a display of conventional ECG data in units of millivolts or microvolts. The high frequency data are analyzed for their root mean square (RMS) voltage values and the discrete RMS values and related parameters are displayed in real time. The high frequency data from the QRS complex are analyzed with imbedded algorithms to determine the presence or absence of reduced amplitude zones, referred to herein as ''RAZs''. RAZs are displayed as ''go, no-go'' signals on the computer monitor. The RMS and related values of the high frequency components are displayed as time varying signals, and the presence or absence of RAZs may be similarly displayed over time.

Reliability and Reproducibility of Advanced ECG Parameters in Month-to-Month and Year-to-Year Recordings in Healthy Subjects

NASA Technical Reports Server (NTRS)

Starc, Vito; Abughazaleh, Ahmed S.; Schlegel, Todd T.

2014-01-01

Advanced resting ECG parameters such the spatial mean QRS-T angle and the QT variability index (QTVI) have important diagnostic and prognostic utility, but their reliability and reproducibility (R&R) are not well characterized. We hypothesized that the spatial QRS-T angle would have relatively higher R&R than parameters such as QTVI that are more responsive to transient changes in the autonomic nervous system. The R&R of several conventional and advanced ECG para-meters were studied via intraclass correlation coefficients (ICCs) and coefficients of variation (CVs) in: (1) 15 supine healthy subjects from month-to-month; (2) 27 supine healthy subjects from year-to-year; and (3) 25 subjects after transition from the supine to the seated posture. As hypothesized, for the spatial mean QRS-T angle and many conventional ECG parameters, ICCs we-re higher, and CVs lower than QTVI, suggesting that the former parameters are more reliable and reproducible.

NIR detection of pits and pit fragments in fresh cherries (abstract)

USDA-ARS?s Scientific Manuscript database

The feasibility of using near infrared (NIR) diffuse reflectance spectroscopy for the detection of pits and pit fragments in cherries was demonstrated. For detection of whole pits, 300 cherries were obtained locally and pits were removed from half. NIR reflectance spectra were obtained in triplicate...

Dynamic Changes of QRS Morphology of Premature Ventricular Contractions During Ablation in the Right Ventricular Outflow Tract: A Case Report.

PubMed

Yue-Chun, Li; Jia-Feng, Lin; Jia-Xuan, Lin

2015-10-01

Electrocardiographic characteristics can be useful in differentiating between right ventricular outflow tract (RVOT) and aortic sinus cusp (ASC) ventricular arrhythmias. Ventricular arrhythmias originating from ASC, however, show preferential conduction to RVOT that may render the algorithms of electrocardiographic characteristics less reliable. Even though there are few reports describing ventricular arrhythmias with ASC origins and endocardial breakout sites of RVOT, progressive dynamic changes in QRS morphology of the ventricular arrhythmias during ablation obtained were rare.This case report describes a patient with symptomatic premature ventricular contractions of left ASC origin presenting an electrocardiogram (ECG) characteristic of right ventricular outflow tract before ablation. Pacing at right ventricular outflow tract reproduced an excellent pace map. When radiofrequency catheter ablation was applied to the right ventricular outflow tract, the QRS morphology of premature ventricular contractions progressively changed from ECG characteristics of right ventricular outflow tract origin to ECG characteristics of left ASC origin.Successful radiofrequency catheter ablation was achieved at the site of the earliest ventricular activation in the left ASC. The distance between the successful ablation site of the left ASC and the site with an excellent pace map of the RVOT was 20 mm.The ndings could be strong evidence for a preferential conduction via the myocardial bers from the ASC origin to the breakout site in the right ventricular outflow tract. This case demonstrates that ventricular arrhythmias with a single origin and exit shift may exhibit QRS morphology changes.

The role of electrocardiography in evaluation of severity of chronic obstructive pulmonary disease in daily clinical practice.

PubMed

Aktürk, Faruk; Bıyık, İsmail; Kocaş, Cüneyt; Ertürk, Mehmet; Yalçın, Ahmet Arif; Savaş, Ayfer Utku; Kuzer, Firuzan Pınar; Uzun, Fatih; Yıldırım, Aydın; Uslu, Nevzat; Çuhadaroğlu, Çağlar

2013-01-01

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of chronic morbidity and mortality. Bronchial obstruction and increased pulmonary vascular resistance impairs right atrial functions. In this study, we aimed to investigate the effect of bronchial obstruction on p wave axis in patients with COPD and usefulness of electrocardiography (ECG) in the evaluation of the severity of COPD. Ninety five patients (64 male and 31 female) included to the study. Patients were in sinus rhythm, with normal ejection fraction and heart chamber sizes. Their respiratory function tests and 12 lead electrocardiograms were obtained at same day. Correlations with severity of COPD and ECG findings including p wave axis, p wave duration, QRS axis, QRS duration were studied. The mean age was 58 ± 12 years. Their mean p wave axis was 62 ± 18 degrees. In this study, p wave axis has demonstrated significant positive correlations with stages of COPD and QRS axis but significant negative correlations with FEV1, FEF, BMI and QRS duration. P wave axis increases with increasing stages of COPD. Verticalization of the frontal p wave axis may be an early finding of worsening of COPD before occurrences of other ECG changes of hypertrophy and enlargement of right heart chambers such as p pulmonale. Verticalization of the frontal p wave axis reflecting right atrial electrical activity and right heart strain may be a useful parameter for quick estimation of the severity of COPD in an out-patient cared.

52 Genetic Loci Influencing Myocardial Mass

PubMed Central

van der Harst, Pim; van Setten, Jessica; Verweij, Niek; Vogler, Georg; Franke, Lude; Maurano, Matthew T.; Wang, Xinchen; Leach, Irene Mateo; Eijgelsheim, Mark; Sotoodehnia, Nona; Hayward, Caroline; Sorice, Rossella; Meirelles, Osorio; Lyytikäinen, Leo-Pekka; Polašek, Ozren; Tanaka, Toshiko; Arking, Dan E.; Ulivi, Sheila; Trompet, Stella; Müller-Nurasyid, Martina; Smith, Albert V.; Dörr, Marcus; Kerr, Kathleen F.; Magnani, Jared W.; Fabiola Del Greco, M.; Zhang, Weihua; Nolte, Ilja M.; Silva, Claudia T.; Padmanabhan, Sandosh; Tragante, Vinicius; Esko, Tõnu; Abecasis, Gonçalo R.; Adriaens, Michiel E.; Andersen, Karl; Barnett, Phil; Bis, Joshua C.; Bodmer, Rolf; Buckley, Brendan M.; Campbell, Harry; Cannon, Megan V.; Chakravarti, Aravinda; Chen, Lin Y.; Delitala, Alessandro; Devereux, Richard B.; Doevendans, Pieter A.; Dominiczak, Anna F.; Ferrucci, Luigi; Ford, Ian; Gieger, Christian; Harris, Tamara B.; Haugen, Eric; Heinig, Matthias; Hernandez, Dena G.; Hillege, Hans L.; Hirschhorn, Joel N.; Hofman, Albert; Hubner, Norbert; Hwang, Shih-Jen; Iorio, Annamaria; Kähönen, Mika; Kellis, Manolis; Kolcic, Ivana; Kooner, Ishminder K.; Kooner, Jaspal S.; Kors, Jan A.; Lakatta, Edward G.; Lage, Kasper; Launer, Lenore J.; Levy, Daniel; Lundby, Alicia; Macfarlane, Peter W.; May, Dalit; Meitinger, Thomas; Metspalu, Andres; Nappo, Stefania; Naitza, Silvia; Neph, Shane; Nord, Alex S.; Nutile, Teresa; Okin, Peter M.; Olsen, Jesper V.; Oostra, Ben A.; Penninger, Josef M.; Pennacchio, Len A.; Pers, Tune H.; Perz, Siegfried; Peters, Annette; Pinto, Yigal M.; Pfeufer, Arne; Pilia, Maria Grazia; Pramstaller, Peter P.; Prins, Bram P.; Raitakari, Olli T.; Raychaudhuri, Soumya; Rice, Ken M.; Rossin, Elizabeth J.; Rotter, Jerome I.; Schafer, Sebastian; Schlessinger, David; Schmidt, Carsten O.; Sehmi, Jobanpreet; Silljé, Herman H.W.; Sinagra, Gianfranco; Sinner, Moritz F.; Slowikowski, Kamil; Soliman, Elsayed Z.; Spector, Timothy D.; Spiering, Wilko; Stamatoyannopoulos, John A.; Stolk, Ronald P.; Strauch, Konstantin; Tan, Sian-Tsung; Tarasov, Kirill V.; Trinh, Bosco; Uitterlinden, Andre G.; van den Boogaard, Malou; van Duijn, Cornelia M.; van Gilst, Wiek H.; Viikari, Jorma S.; Visscher, Peter M.; Vitart, Veronique; Völker, Uwe; Waldenberger, Melanie; Weichenberger, Christian X.; Westra, Harm-Jan; Wijmenga, Cisca; Wolffenbuttel, Bruce H.; Yang, Jian; Bezzina, Connie R.; Munroe, Patricia B.; Snieder, Harold; Wright, Alan F.; Rudan, Igor; Boyer, Laurie A.; Asselbergs, Folkert W.; van Veldhuisen, Dirk J.; Stricker, Bruno H.; Psaty, Bruce M.; Ciullo, Marina; Sanna, Serena; Lehtimäki, Terho; Wilson, James F.; Bandinelli, Stefania; Alonso, Alvaro; Gasparini, Paolo; Jukema, J. Wouter; Kääb, Stefan; Gudnason, Vilmundur; Felix, Stephan B.; Heckbert, Susan R.; de Boer, Rudolf A.; Newton-Cheh, Christopher; Hicks, Andrew A.; Chambers, John C.; Jamshidi, Yalda; Visel, Axel; Christoffels, Vincent M.; Isaacs, Aaron; Samani, Nilesh J.; de Bakker, Paul I.W.

2017-01-01

BACKGROUND Myocardial mass is a key determinant of cardiac muscle function and hypertrophy. Myocardial depolarization leading to cardiac muscle contraction is reflected by the amplitude and duration of the QRS complex on the electrocardiogram (ECG). Abnormal QRS amplitude or duration reflect changes in myocardial mass and conduction, and are associated with increased risk of heart failure and death. OBJECTIVES This meta-analysis sought to gain insights into the genetic determinants of myocardial mass. METHODS We carried out a genome-wide association meta-analysis of 4 QRS traits in up to 73,518 individuals of European ancestry, followed by extensive biological and functional assessment. RESULTS We identified 52 genomic loci, of which 32 are novel, that are reliably associated with 1 or more QRS phenotypes at p < 1 × 10−8. These loci are enriched in regions of open chromatin, histone modifications, and transcription factor binding, suggesting that they represent regions of the genome that are actively transcribed in the human heart. Pathway analyses provided evidence that these loci play a role in cardiac hypertrophy. We further highlighted 67 candidate genes at the identified loci that are preferentially expressed in cardiac tissue and associated with cardiac abnormalities in Drosophila melanogaster and Mus musculus. We validated the regulatory function of a novel variant in the SCN5A/SCN10A locus in vitro and in vivo. CONCLUSIONS Taken together, our findings provide new insights into genes and biological pathways controlling myocardial mass and may help identify novel therapeutic targets. PMID:27659466

Collapse and Fragmentation of Molecular Cloud Cores. VII. Magnetic Fields and Multiple Protostar Formation

NASA Astrophysics Data System (ADS)

Boss, Alan P.

2002-04-01

Recent observations of star-forming regions suggest that binary and multiple young stars are the rule rather than the exception and implicate fragmentation as the likely mechanism for their formation. Most numerical hydrodynamic calculations of fragmentation have neglected the possibly deleterious effects of magnetic fields, despite ample evidence for the importance of magnetic support of precollapse clouds. We present here the first numerical hydrodynamic survey of the collapse and fragmentation of initially magnetically supported clouds that takes into account several magnetic field effects in an approximate manner. The models are calculated with a three-dimensional, finite differences code that solves the equations of hydrodynamics, gravitation, and radiative transfer in the Eddington and diffusion approximations. Magnetic field effects are included through two simple approximations: magnetic pressure is added to the gas pressure, and magnetic tension is approximated by gravity dilution once collapse is well underway. Ambipolar diffusion of the magnetic field leading to cloud collapse is treated approximately as well. Models are calculated for a variety of initial cloud density profiles, shapes, and rotation rates. We find that in spite of the inclusion of magnetic field effects, dense cloud cores are capable of fragmenting into binary and multiple protostar systems. Initially prolate clouds tend to fragment into binary protostars, while initially oblate clouds tend to fragment into multiple protostar systems containing a small number (of the order of 4) of fragments. The latter are likely to be subject to rapid orbital evolution, with close encounters possibly leading to the ejection of fragments. Contrary to expectation, magnetic tension effects appear to enhance fragmentation, allowing lower mass fragments to form than would otherwise be possible, because magnetic tension helps to prevent a central density singularity from forming and producing a dominant single object. Magnetically supported dense cloud cores thus seem to be capable of collapsing and fragmenting into sufficient numbers of binary and multiple protostar systems to be compatible with observations of the relative rarity of single protostars.

Real-Time, High-Frequency QRS Electrocardiograph

NASA Technical Reports Server (NTRS)

Schlegel, Todd T.; DePalma, Jude L.; Moradi, Saeed

2003-01-01

An electronic system that performs real-time analysis of the low-amplitude, high-frequency, ordinarily invisible components of the QRS portion of an electrocardiographic signal in real time has been developed. Whereas the signals readily visible on a conventional electrocardiogram (ECG) have amplitudes of the order of a millivolt and are characterized by frequencies <100 Hz, the ordinarily invisible components have amplitudes in the microvolt range and are characterized by frequencies from about 150 to about 250 Hz. Deviations of these high-frequency components from a normal pattern can be indicative of myocardial ischemia or myocardial infarction

Packet Fragmentation and Reassembly in Molecular Communication.

PubMed

Furubayashi, Taro; Nakano, Tadashi; Eckford, Andrew; Okaie, Yutaka; Yomo, Tetsuya

2016-04-01

This paper describes packet fragmentation and reassembly to achieve reliable molecular communication among bionanomachines. In the molecular communication described in this paper, a sender bionanomachine performs packet fragmentation, dividing a large molecular message into smaller pieces and embedding into smaller molecular packets, so that molecular packets have higher diffusivity to reach the receiver bionanomachine. The receiver bionanomachine then performs packet reassembly to retrieve the original molecular message from a set of molecular packets that it receives. To examine the effect of packet fragmentation and reassembly, we develop analytical models and conduct numerical experiments. Numerical results show that packet fragmentation and reassembly can improve the message delivery performance. Numerical results also indicate that packet fragmentation and reassembly may degrade the performance in the presence of drift in the environment.

Magnetic Fields and Multiple Protostar Formation

NASA Astrophysics Data System (ADS)

Boss, A. P.

2001-12-01

Recent observations of star-forming regions suggest that binary and multiple young stars are the rule rather than the exception, and implicate fragmentation as the likely mechanism for their formation. Most numerical hydrodynamical calculations of fragmentation have neglected the possibly deleterious effects of magnetic fields, in spite of ample evidence for the importance of magnetic support of pre-collapse clouds. We present here the first numerical hydrodynamical survey of the full effects of magnetic fields on the collapse and fragmentation of dense cloud cores. The models are calculated with a three dimensional, finite differences code which solves the equations of hydrodynamics, gravitation, and radiative transfer in the Eddington and diffusion approximations. Magnetic field effects are included through two simple approximations: magnetic pressure is added to the gas pressure, and magnetic tension is approximated by gravity dilution once collapse is well underway. Ambipolar diffusion of the magnetic field leading to cloud collapse is treated approximately as well. Models are calculated for a variety of initial cloud density profiles, shapes, and rotation rates. We find that in spite of the inclusion of magnetic field effects, dense cloud cores are capable of fragmenting into binary and multiple protostar systems. Initially prolate clouds tend to fragment into binary protostars, while initially oblate clouds tend to fragment into multiple protostar systems containing a small number (of order four) of fragments. The latter are likely to be subject to rapid orbital evolution, with close encounters possibly leading to the ejection of fragments. Contrary to expectation, magnetic tension effects appear to enhance fragmentation, allowing lower mass fragments to form than would otherwise be possible, because magnetic tension helps to prevent a central density singularity from forming and producing a dominant single object. Magnetically-supported dense cloud cores thus seem to be capable of collapsing and fragmenting into sufficient numbers of binary and multiple protostar systems to be compatible with observations of the relative rarity of single protostars. This work was partially supported by NSF grants AST-9983530 and MRI-9976645.

Fetal Heart Rate Monitoring Using Maternal Abdominal Surface Electrodes in Third Trimester: Can We Obtain Additional Information Other than CTG Trace?

PubMed

Fuchs, Tomasz; Grobelak, Krzysztof; Pomorski, Michał; Zimmer, Mariusz

2016-01-01

Cardiotocography (CTG) is the most widely used procedure despite its low specificity for fetal acidosis and poor perinatal outcome. Fetal electrocardiography (fECG) with transabdominal electrodes is a new, non-invasive and promising method with greater potential for detecting impairment of fetal circulation. This study is the first that attempts to assess the usefulness of fECG in comparison to CTG during antepartum period. To determine if a single fECG examination along with CTG tracing and Doppler flow measurement in the fetal vessels has any additional clinical value in normal and intrauterine growth restricted (IUGR) fetuses. The study included 93 pregnancies with IUGR, 37 pregnancies with IUGR and brain sparing effect, and 324 healthy pregnant women. The T/QRS ratio, cerebro-placental ratio (CRP), and CTG tracings were analyzed. One-way analysis of variance and Spearman's rank correlation coefficient were applied. The relationship between results of the T/QRS ratio and CTG examination among the study groups was analyzed. The highest average mean value of the T/QRS ratio was recorded in the IUGR group with a normal CPR and a pathologic CTG (0.235 ± 0.014). The highest average maximum values were observed in the groups of IUGR pregnancies with a reduced CPR with normal (0.309 ± 0.100), suspicious (0.330 ± 0.102) and pathologic (0.319 ± 0.056) CTGs. Analysis of variance revealed differences between study groups regarding maximum values and the difference between maximum and minimal values of T/QRS. Correlations between groups were insignificant. Higher values of T/QRS ratio in IUGR pregnancies with normal and reduced CPR than in control group regardless of the result of CTG examination may indicate minimal worsening of intrauterine fetal well-being in growth retarded fetuses. No relationship between fECG examination and CTG tracings suggests that a single fECG does not provide any additional clinically significant information determining the condition of the fetus; however, further studies are required.

[Problems with Using Hospital Quality Reports as a Secondary Data Source for Health Services Research in Germany].

PubMed

Kraska, R A; de Cruppe, W; Geraedts, M

2017-07-01

Background Since 2005, German hospitals are required by law to publish structured quality reports (QRs). Because of the detailed data basis, the QRs are being increasingly used for secondary data analyses in health services research. Up until now, methodological difficulties that can cause distorted results of the analyses have essentially been overlooked. The aim of this study is to systematically list the methodological problems associated with using QR and to suggest solution strategies. Methods The QRs from 2006-2012 form the basis of the analyses and were aggregated in a database using an individualized data linkage procedure. Thereafter, a correlation analysis between a quality indicator and the staffing of hospitals was conducted, serving as an example for both cross-sectional as well as longitudinal studies. The resulting methodological problems are described qualitatively and quantitatively, and potential solutions are derived from the statistical literature. Results In each reporting year, 2-15% of the hospitals delivered no QR. In 2-16% of the QRs, it is not recognizable whether a report belongs to a hospital network or a single location. In addition, 6-66% of the location reports falsely contain data from the hospital network. 10% of the hospitals changed their institution code (IC), in 5% of the cases, the same "IC-location-number-combination" was used for different hospitals over the years. Therefore, 10-20% of the QRs cannot be linked with the IC as key variable. As a remedy for the linking of QR, the combination of the IC, the address and the number of beds represents a suitable solution. Using this solution, hospital network reports, location reports and missing reports can be identified and considered in an analysis. Conclusions Secondary data analyses with quality reports provide a high potential for error due to the inconsistent data base and the problems of the data linkage procedure. These can distort calculated parameters and limit the validity of results. Only the unequivocal identification of the reporting hospitals guarantees meaningful results. © Georg Thieme Verlag KG Stuttgart · New York.

Sokolow-Lyon voltage is suitable for monitoring improvement in cardiac function and prognosis of patients with idiopathic dilated cardiomyopathy.

PubMed

Fukaya, Kenji; Takeshita, Kyosuke; Okumura, Takahiro; Hiraiwa, Hiroaki; Aoki, Soichiro; Ichii, Takeo; Sugiura, Yuki; Kitagawa, Katsuhide; Kondo, Toru; Watanabe, Naoki; Kano, Naoaki; Furusawa, Kenji; Sawamura, Akinori; Morimoto, Ryota; Bando, Yasuko; Murohara, Toyoaki

2017-09-01

The clinical significance of electrocardiogram in the assessment of patients with idiopathic dilated cardiomyopathy (IDCM) is currently unknown. The aim of this study was to determine the feasibility of recording serial changes in Sokolow-Lyon voltage (∆%QRS-voltage) in one year to estimate left ventricular reverse remodeling (LVRR) and predict a prognosis of IDCM patients under tailored medical therapy. Sixty-eight consecutive patients with mild symptoms (52.1 ± 13 years old; 69% men; NYHA I/II/III/IV; 33/29/6/0) underwent electrocardiography and echocardiography at baseline and 12 month follow-up (follow-up period: 3.9 years). LVRR was observed in 30 patients (44.1%). The ∆%QRS-voltage was significantly lower in the LVRR group (LVRR; -26.9%, non-LVRR: -9.2%, p < .001). Univariate analysis showed that ∆%QRS-voltage correlated with ∆%LV end-diastolic diameter (r = .634, p < .001), and with ∆%LV ejection fraction and ∆%LV mass index (r = -.412, p < .001; r = .429, p < .001 respectively). Using receiver operating characteristic curve analysis for the estimation of LVRR, ∆%QRS of -14.7% showed optimal sensitivity (63.2%) and specificity (83.3%) (AUC = 0.775, p < .001). The composite endpoints of cardiac death (n = 0), hospitalization for advanced heart failure (n = 11) and fatal arrhythmia (n = 2) were observed in 13 patients during the follow-up period. Kaplan-Meier analysis showed significantly higher event-free rate in patients of the low ∆%QRS-voltage group (<-14.7%) (83%) than those of the high group (66%, p = .022). The present study showed that decrease in Sokolow-Lyon voltage is associated with improvement in cardiac function and favorable prognosis in IDCM patients on medical therapy, suggesting that this index is a feasible marker for response to treatment of IDCM. © 2017 Wiley Periodicals, Inc.

Ischemia episode detection in ECG using kernel density estimation, support vector machine and feature selection

PubMed Central

2012-01-01

Background Myocardial ischemia can be developed into more serious diseases. Early Detection of the ischemic syndrome in electrocardiogram (ECG) more accurately and automatically can prevent it from developing into a catastrophic disease. To this end, we propose a new method, which employs wavelets and simple feature selection. Methods For training and testing, the European ST-T database is used, which is comprised of 367 ischemic ST episodes in 90 records. We first remove baseline wandering, and detect time positions of QRS complexes by a method based on the discrete wavelet transform. Next, for each heart beat, we extract three features which can be used for differentiating ST episodes from normal: 1) the area between QRS offset and T-peak points, 2) the normalized and signed sum from QRS offset to effective zero voltage point, and 3) the slope from QRS onset to offset point. We average the feature values for successive five beats to reduce effects of outliers. Finally we apply classifiers to those features. Results We evaluated the algorithm by kernel density estimation (KDE) and support vector machine (SVM) methods. Sensitivity and specificity for KDE were 0.939 and 0.912, respectively. The KDE classifier detects 349 ischemic ST episodes out of total 367 ST episodes. Sensitivity and specificity of SVM were 0.941 and 0.923, respectively. The SVM classifier detects 355 ischemic ST episodes. Conclusions We proposed a new method for detecting ischemia in ECG. It contains signal processing techniques of removing baseline wandering and detecting time positions of QRS complexes by discrete wavelet transform, and feature extraction from morphology of ECG waveforms explicitly. It was shown that the number of selected features were sufficient to discriminate ischemic ST episodes from the normal ones. We also showed how the proposed KDE classifier can automatically select kernel bandwidths, meaning that the algorithm does not require any numerical values of the parameters to be supplied in advance. In the case of the SVM classifier, one has to select a single parameter. PMID:22703641

Usefulness of Derived Frank Lead Parameters in Screening for Coronary Artery Disease and Cardiomyopathy

NASA Technical Reports Server (NTRS)

DePalma, J. L.; Schlegel, T. T.; Arenare, B.; Greco, E. C.; Starc, V.; Rahman, M. A.; Delgado, R.

2007-01-01

We investigated the accuracy of several known as well as newly-introduced derived Frank-lead ECG parameters in differentiating healthy individuals from patients with obstructive coronary artery disease (CAD) and cardiomyopathy (CM). Advanced high-fidelity 12-lead ECG tests (approx. 5-min supine) were first performed on a "training set" of 99 individuals: 33 with ischemic or dilated CM and low ejection fraction (EF less than 40%); 33 with catheterization-proven obstructive CAD but normal EF; and 33 age-/gender-matched healthy controls. The following derived Frank lead parameters were studied for their accuracy in detecting CAD and CM: the spatial ventricular gradient (VG), including its beat-to-beat coefficient of variability (VG CV); the spatial mean QRS (SM-QRS) and T-waves (SM-T) and their beat-to-beat coefficients of variability; the spatial ventricular activation time (VAT); the mean and maximum spatial QRS-T angles; and standard late potentials parameters (RMS40, fQRSD and LAS). Several of these parameters were accurate in discriminating between the control group and both diseased groups at p less than 0.0001. For example the fQRSD, VG CV, mean spatial QRS-T angle and VG minus SM-QRS (which is similar to the SM-T) had retrospective areas under the ROC curve of 0.78, 0.78, 0.80, and 0.84 (CAD vs. controls) and 0.93, 0.88, 0.98 and 0.99 (CM vs. controls), respectively. The single most effective parameter in discriminating between the CAD and CM groups was the spatial VAT (44 plus or minus 5.8 vs. 53 plus or minus 9.9 ms, p less than 0.0001), with an area under the ROC curve of 0.80. Since subsequent prospective analyses using new groups of patients and healthy subjects have yielded only slightly less accurate results, we conclude that derived Frank-lead parameters show great promise for potentially contributing to the development of a rapid and inexpensive resting ECG-based screening test for heart disease.

Value of the Electrocardiographic (P Wave, T Wave, QRS) Axis as a Predictor of Mortality in 14 Years in a Population With a High Prevalence of Chagas Disease from the Bambuí Cohort Study of Aging.

PubMed

Moraes, Diego N; Nascimento, Bruno R; Beaton, Andrea Z; Soliman, Elsayed Z; Lima-Costa, Maria Fernanda; Dos Reis, Rodrigo C P; Ribeiro, Antonio Luiz P

2018-02-01

We sought to investigate the prognostic value of the electrocardiogram (ECG) electrical axes (P wave, T wave and QRS) as predictors of mortality in the 14-year follow-up of the prospective cohort of all residents ≥60 years living in the southeastern Brazilian city of Bambuí, a population with high prevalence of Chagas disease (ChD). Baseline ECG axes were automatically measured with normal values defined as follows: P-wave axis 0° to 75°, QRS axis -30° to 90°, and T axis 15° to 75°. Participants underwent annual follow-up visits and death was verified using death certificates. Cox proportional hazards regression was used to assess the prognostic value of ECG axes for all-cause mortality, after adjustment for potential confounders. From 1,742 qualifying residents, 1,462 were enrolled, of whom 557 (38.1%) had ChD. Mortality rate was 51.9%. In multivariable adjusted models, abnormal P-wave axis was associated with a 48% (hazard ratio [HR] = 1.48 [95% confidence interval (CI) 1.16-1.88]) increased mortality risk in patients with ChD and 43% (HR = 1.43 [CI 1.13-1.81]) in patients without ChD. Abnormal QRS axis was associated with a 34% (HR = 1.34 [CI 1.04-1.73]) increased mortality risk in patients with ChD, but not in individuals without ChD. Similarly, in the ChD group, abnormal T-wave axis was associated with a 35% (HR = 1.35 [CI 1.07-1.71]) increased mortality, but not in patients without ChD. In conclusion, abnormal P-wave, QRS, and T-wave axes were associated with increased all-cause mortality in patients with ChD. Abnormal P-wave axis was associated with mortality also among those without ChD, being the strongest predictor among ECG variables. Copyright © 2017 Elsevier Inc. All rights reserved.

Diagnosis and ablation of multiform fascicular tachycardia.

PubMed

Sung, Raphael K; Kim, Albert M; Tseng, Zian H; Han, Frederick; Inada, Keiichi; Tedrow, Usha B; Viswanathan, Mohan N; Badhwar, Nitish; Varosy, Paul D; Tanel, Ronn; Olgin, Jeffrey E; Stephenson, William G; Scheinman, Melvin

2013-03-01

Fascicular tachycardia (FT) is an uncommon cause of monomorphic sustained ventricular tachycardia (VT). We describe 6 cases of FT with multiform QRS morphologies. Six of 823 consecutive VT cases were retrospectively analyzed and found attributable to FT with multiform QRS patterns, with 3 cases exhibiting narrow QRS VT as well. All underwent electrophysiology study including fascicular potential mapping, entrainment pacing, and electroanatomic mapping. The first 3 cases describe similar multiform VT patterns with successful ablation in the upper mid septum. Initially, a right bundle branch block (RBBB) VT with superior axis was induced. Radiofrequency catheter ablation (RFCA) targeting the left posterior fascicle (LPF) resulted in a second VT with RBBB inferior axis. RFCA in the upper septum just apical to the LBB potential abolished VT in all cases. Cases 4 and 5 showed RBBB VT with alternating fascicular block compatible with upper septal dependent VT, resulting in bundle branch reentrant VT (BBRT) after ablation of LPF and left anterior fascicle (LAF). Finally, Cases 5 and 6 demonstrated spontaneous shift in QRS morphology during VT, implicating participation of a third fascicle. In Case 6, successful ablation was achieved over the proximal LAF, likely representing insertion of the auxiliary fascicle near the proximal LAF. Multiform FTs show a reentrant mechanism using multiple fascicular branches. We hypothesize that retrograde conduction over the septal fascicle produces alternate fascicular patterns as well as narrow VT forms. Ablation of the respective fascicle was successful in abolishing FT but does not preclude development of BBRT unless septal fascicle is targeted and ablated. © 2012 Wiley Periodicals, Inc.

Are classic predictors of voltage valid in cardiac amyloidosis? A contemporary analysis of electrocardiographic findings.

PubMed

Sperry, Brett W; Vranian, Michael N; Hachamovitch, Rory; Joshi, Hariom; McCarthy, Meghann; Ikram, Asad; Hanna, Mazen

2016-07-01

Low voltage electrocardiography (ECG) coupled with increased ventricular wall thickness is the hallmark of cardiac amyloidosis. However, patient characteristics influencing voltage in the general population, including bundle branch block, have not been evaluated in amyloid heart disease. A retrospective analysis was performed of patients with newly diagnosed cardiac amyloidosis from 2002 to 2014. ECG voltage was calculated using limb (sum of QRS complex in leads I, II and III) and precordial (Sokolow: S in V1 plus R in V5-V6) criteria. The associations between voltage and clinical variables were tested using multivariable linear regression. A Cox model assessed the association of voltage with mortality. In 389 subjects (transthyretin ATTR 186, light chain AL 203), 30% had conduction delay (QRS >120ms). In those with narrow QRS, 68% met low limb, 72% low Sokolow and 57% both criteria, with lower voltages found in AL vs ATTR. LV mass index as well as other typical factors that impact voltage (age, sex, race, hypertension, BSA, and smoking) in the general population were not associated with voltage in this cardiac amyloidosis cohort. Patients with LBBB and IVCD had similar voltages when compared to those with narrow QRS. Voltage was significantly associated with mortality (p<0.001 for both criteria) after multivariable adjustment. Classic predictors of ECG voltage in the general population are not valid in cardiac amyloidosis. In this cohort, the prevalence estimates of ventricular conduction delay and low voltage are higher than previously reported. Voltage predicts mortality after multivariable adjustment. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Characteristics of Responders to Cardiac Resynchronization Therapy: The Impact of Echocardiographic Left Ventricular Volume

PubMed Central

Park, Mi Young; Altman, Robert K.; Orencole, Mary; Kumar, Prabhat; Parks, Kimberly A.; Heist, Kevin E.; Singh, Jagmeet P.; Picard, Michael H.

2012-01-01

Summary Background One third of patients who receive cardiac resynchronization therapy (CRT) are classified as nonresponders. Characteristics of responders to CRT have been studied in multiple clinical trials. Hypothesis We aimed to examine characteristics of CRT responders in a routine clinical practice. Method One hundred and twenty five patients were examined retrospectively from a multidisciplinary CRT clinic program. Echocardiographic CRT response was defined as a decrease in left ventricular (LV) end systolic volume (ESV) of ≥ 15% and/or absolute increase of 5% in LV ejection fraction (EF) at 6 month visit. Results There were 81 responders and 44 nonresponders. By univariate analyses, female gender, nonischemic cardiomyopathy etiology, baseline QRS duration, the presence of left bundle branch block (LBBB) and left ventricular end-diastolic volume (LVEDV) index predicted CRT response. However, multivariate analysis demonstrated only QRS duration, LBBB and LVEDV index were independent predictors (QRS width: Odd ratio [OR] 1.027, 95% CI 1.004 – 1.050, p = 0.023; LBBB: OR 3.568, 95% CI 1.284 – 9.910, p=0.015; LV EDV index: OR 0.970, 95% CI 0.953 – 0.987, p= 0.001). While female gender and nonischemic etiology were associated with an improved CRT response on univariate analyses, after adjusting for LV volumes, they were not independent predictors. Conclusion QRS width, LBBB and LVEDV index are independent predictors for echocardiographic CRT response. Previously reported differences in CRT response for gender and cardiomyopathy etiology are associated with differences in baseline LV volumes in our clinical practice. PMID:22886700

QRS Width as a Predictor of Right Ventricular Remodeling After Percutaneous Pulmonary Valve Implantation.

PubMed

Paech, C; Dähnert, I; Riede, F T; Wagner, R; Kister, T; Nieschke, K; Wagner, F; Gebauer, R A

2017-08-01

Recent data showed a right ventricular dyssynchrony in patients with tetralogy of Fallot (TOF). Percutaneous pulmonary valve implantation (PPVI) has become an important procedure to treat a pulmonary stenosis and/or regurgitation of the right ventricular outflow tract in these patients. Despite providing good results, there is still a considerable number of nonresponders to PPVI. The authors speculated that electrical dysfunction of the right ventricle plays an underestimated role in the outcome of patients after PPVI. This study aimed to investigate the influence of right ventricular electrical dysfunction, i.e., right bundle branch block (RBBB) on the RV remodeling after PPVI. The study included consecutive patients after correction of TOF with or without RBBB, who had received a PPVI previously at the Heart Center of the University of Leipzig, Germany during the period from 2012 to 2015. 24 patients were included. Patients without RBBB, i.e., with narrow QRS complexes pre-intervention, had significantly better RV function and had smaller right ventricular volumes. Patients with pre-interventionally QRS width below 150 ms showed a post-interventional remodeling of the right ventricle with the decreasing RV volumes (p = 0.001). The parameters of LV function and volume as well as RV ejection fraction remained unaffected by RBBB. The presented data indicate that the QRS width seems to be a valuable parameter in the prediction of right ventricular remodeling after PPVI, as it represents both electrical and mechanical functions of the right ventricle and may serve as an additional parameter for optimal timing of a PPVI.

Left ventricular outflow tract arrhythmias with divergent QRS morphology: mapping of different exits and ablation strategy.

PubMed

Reithmann, Christopher; Fiek, Michael

2018-01-01

Ventricular arrhythmias (VAs) from the left ventricular outflow tract (LVOT) can have multiple exits exhibiting divergent ECG features. In a series of 131 patients with VAs with LVOT origin, 10 patients presented with divergent QRS morphologies. Multisite endo- and epicardial mapping of different exit sites was performed. The earliest ventricular activity of 23 LVOT VAs in 10 patients was detected in the endocardium of the LV in 7 patients, the aortic sinuses of Valsalva (SoV) in 3 patients, the distal coronary sinus in 6 patients, the anterior interventricular vein in 3 patients, and the posterior right ventricular outflow tract (RVOT) in 4 patients. Simultaneous elimination of two divergent QRS morphologies of LVOT VAs by ablation from a single site was achieved in 5 patients (aorto-mitral continuity in 3 patients, SoV and RVOT in each 1 patient) using a mean maximum ablation energy of 46 ± 5 W. Sequential ablation from two or three different sites, including trans-pericardial and distal coronary sinus ablation in each 2 patients, led to elimination of the divergent VA QRS morphologies in the other 5 patients. During the follow-up of 28 ± 29 months, 4 of the 10 patients had recurrence of at least one LVOT VA. A 43-year-old patient with muscular dystrophy Curschmann-Steinert had recurrence of sustained LVOT VTs and died of sudden cardiac death. Multisite mapping of different exit sites of LVOT VAs can guide ablation of intramural foci but the recurrence rate after initially successful ablation was high.

Evaluation of mechanical dyssynchrony and myocardial perfusion using phase analysis of gated SPECT imaging in patients with left ventricular dysfunction

PubMed Central

Trimble, Mark A.; Borges-Neto, Salvador; Honeycutt, Emily F.; Shaw, Linda K.; Pagnanelli, Robert; Chen, Ji; Iskandrian, Ami E.; Garcia, Ernest V.; Velazquez, Eric J.

2010-01-01

Background Using phase analysis of gated single photon emission computed tomography (SPECT) imaging, we examined the relation between myocardial perfusion, degree of electrical dyssynchrony, and degree of SPECT-derived mechanical dyssynchrony in patients with left ventricular (LV) dysfunction. Methods and Results We retrospectively examined 125 patients with LV dysfunction and ejection fraction of 35% or lower. Fourier analysis converts regional myocardial counts into a continuous thickening function, allowing resolution of phase of onset of myocardial thickening. The SD of LV phase distribution (phase SD) and histogram bandwidth describe LV phase dispersion as a measure of dyssynchrony. Heart failure (HF) patients with perfusion abnormalities ities have higher degrees of dyssynchrony measured by median phase SD (45.5° vs 27.7°, P < .0001) and bandwidth (117.0° vs 73.0°, P = .0006). HF patients with prolonged QRS durations have higher degrees of dyssynchrony measured by median phase SD (54.1° vs 34.7°, P < .0001) and bandwidth (136.5° vs 99.0°, P = .0005). Mild to moderate correlations exist between QRS duration and phase analysis indices of phase SD (r = 0.50) and bandwidth (r = 0.40). Mechanical dyssynchrony (phase SD >43°) was 43.2%. Conclusions HF patients with perfusion abnormalities or prolonged QRS durations QRS durations have higher degrees of mechanical dyssynchrony. Gated SPECT myocardial perfusion imaging can quantify myocardial function, perfusion, and dyssynchrony and may help in evaluating patients for cardiac resynchronization therapy. PMID:18761269

Modeling habitat split: landscape and life history traits determine amphibian extinction thresholds.

PubMed

Fonseca, Carlos Roberto; Coutinho, Renato M; Azevedo, Franciane; Berbert, Juliana M; Corso, Gilberto; Kraenkel, Roberto A

2013-01-01

Habitat split is a major force behind the worldwide decline of amphibian populations, causing community change in richness and species composition. In fragmented landscapes, natural remnants, the terrestrial habitat of the adults, are frequently separated from streams, the aquatic habitat of the larvae. An important question is how this landscape configuration affects population levels and if it can drive species to extinction locally. Here, we put forward the first theoretical model on habitat split which is particularly concerned on how split distance - the distance between the two required habitats - affects population size and persistence in isolated fragments. Our diffusive model shows that habitat split alone is able to generate extinction thresholds. Fragments occurring between the aquatic habitat and a given critical split distance are expected to hold viable populations, while fragments located farther away are expected to be unoccupied. Species with higher reproductive success and higher diffusion rate of post-metamorphic youngs are expected to have farther critical split distances. Furthermore, the model indicates that negative effects of habitat split are poorly compensated by positive effects of fragment size. The habitat split model improves our understanding about spatially structured populations and has relevant implications for landscape design for conservation. It puts on a firm theoretical basis the relation between habitat split and the decline of amphibian populations.

Collapse and Fragmentation Models of Tidally Interacting Molecular Cloud Cores. IV. Initial Slow Rotation and Magnetic Field Support

NASA Astrophysics Data System (ADS)

Sigalotti, Leonardo Di G.; Klapp, Jaime

2000-03-01

Fragmentation has long been advocated as the primary mechanism for explaining the observed binary frequency among pre-main-sequence stars and, more recently, for explaining the emerging evidence for binary and multiple protostellar systems. The role of magnetic fields and ambipolar diffusion is essential to understand how dense cloud cores begin dynamic collapse and eventually fragment into protostars. Here we consider new numerical models of the gravitational collapse and fragmentation of slowly rotating molecular cloud cores, including the effects of magnetic support and ambipolar diffusion. The starting point of the evolution is provided by a magnetically stable (subcritical) condensation that results from adding a magnetic field pressure, B2/8π [with the field strength given by the scaling relation B=B0(ρ/ρ0)1/2], to a reference state consisting of a thermally supercritical (α~0.36), slowly rotating (β~0.037), Gaussian cloud core of prolate shape and central density ρ0. The effects of ambipolar diffusion are approximated by allowing the reference field strength B0 to gradually decrease over a timescale of 10 free-fall times. The models also include the effects of tidal interaction due to a gravitational encounter with another protostar, and so they may apply to low-mass star formation within a cluster-forming environment. The results indicate that the magnetic forces delay the onset of dynamic collapse, and hence of fragmentation, by an amount of time that depends on the initial central mass-to-flux ratio. Compared with previous magnetic collapse calculations of rapidly rotating (β=0.12) clouds, lower initial rotation (β~0.037) is seen to result in much shorter delay periods, thus anticipating binary fragmentation. In general, the results show that the models are still susceptible to fragment into binary systems. Intermediate magnetic support (η~0.285) and low tidal forces (τ<~0.201) may lead to final triple or quadruple protostellar systems, while increasing the size of η and τ always results in final binary protostellar cores. The formed binary systems have separations of ~200-350 AU, suggesting that the recently observed peaks around ~90 AU and 215 AU for T Tauri stars may be explained by the collapse and fragmentation of initially slowly rotating magnetic cloud cores with β<~0.04.

[Electrocardiographic diagnosis: when QRS is wide.

PubMed

Conti, Matilde; Bregani, Enrico Rino

2018-04-01

Differential diagnosis of one or more wide QRS complexes on an electrocardiogram under emergency conditions takes into account three main sets of clinical conditions: ventricular pre-excitation, aberrant conduction and ventricular beats and it is based on the morphological analysis of the ECG and patient's anamnestic data. Several criteria can facilitate the differential diagnosis and if properly used and integrated with clinic data they can achieve good diagnostic accuracy in most cases. In this review several criteria based on evidence and literature are presented, paying attention in recognizing some morphologic pathways that can be used in emergency room and allow a correct ECG assessment.

Diffusion-model analysis of pPb and PbPb collisions at LHC energies

NASA Astrophysics Data System (ADS)

Schulz, P.; Wolschin, G.

2018-06-01

We present an analysis of centrality-dependent pseudorapidity distributions of produced charged hadrons in pPb and PbPb collisions at the Large Hadron Collider (LHC) energy of s NN = 5.02 TeV, and of minimum-bias pPb collisions at 8.16 TeV within the non-equilibrium-statistical relativistic diffusion model (RDM). In a three-source approach, the role of the fragmentation sources is emphasized. Together with the Jacobian transformation from rapidity to pseudorapidity and the limiting fragmentation conjecture, these are essential for modeling the centrality dependence. For central PbPb collisions, a prediction at the projected FCC energy of s NN = 39 TeV is made.

Stochastic Simulation of Actin Dynamics Reveals the Role of Annealing and Fragmentation

PubMed Central

Fass, Joseph; Pak, Chi; Bamburg, James; Mogilner, Alex

2008-01-01

Recent observations of F-actin dynamics call for theoretical models to interpret and understand the quantitative data. A number of existing models rely on simplifications and do not take into account F-actin fragmentation and annealing. We use Gillespie’s algorithm for stochastic simulations of the F-actin dynamics including fragmentation and annealing. The simulations vividly illustrate that fragmentation and annealing have little influence on the shape of the polymerization curve and on nucleotide profiles within filaments but drastically affect the F-actin length distribution, making it exponential. We find that recent surprising measurements of high length diffusivity at the critical concentration cannot be explained by fragmentation and annealing events unless both fragmentation rates and frequency of undetected fragmentation and annealing events are greater than previously thought. The simulations compare well with experimentally measured actin polymerization data and lend additional support to a number of existing theoretical models. PMID:18279896

An advanced algorithm for fetal heart rate estimation from non-invasive low electrode density recordings.

PubMed

Dessì, Alessia; Pani, Danilo; Raffo, Luigi

2014-08-01

Non-invasive fetal electrocardiography is still an open research issue. The recent publication of an annotated dataset on Physionet providing four-channel non-invasive abdominal ECG traces promoted an international challenge on the topic. Starting from that dataset, an algorithm for the identification of the fetal QRS complexes from a reduced number of electrodes and without any a priori information about the electrode positioning has been developed, entering into the top ten best-performing open-source algorithms presented at the challenge.In this paper, an improved version of that algorithm is presented and evaluated exploiting the same challenge metrics. It is mainly based on the subtraction of the maternal QRS complexes in every lead, obtained by synchronized averaging of morphologically similar complexes, the filtering of the maternal P and T waves and the enhancement of the fetal QRS through independent component analysis (ICA) applied on the processed signals before a final fetal QRS detection stage. The RR time series of both the mother and the fetus are analyzed to enhance pseudoperiodicity with the aim of correcting wrong annotations. The algorithm has been designed and extensively evaluated on the open dataset A (N = 75), and finally evaluated on datasets B (N = 100) and C (N = 272) to have the mean scores over data not used during the algorithm development. Compared to the results achieved by the previous version of the algorithm, the current version would mark the 5th and 4th position in the final ranking related to the events 1 and 2, reserved to the open-source challenge entries, taking into account both official and unofficial entrants. On dataset A, the algorithm achieves 0.982 median sensitivity and 0.976 median positive predictivity.

Comparison of automated measurements of electrocardiographic intervals and durations by computer-based algorithms of digital electrocardiographs.

PubMed

Kligfield, Paul; Badilini, Fabio; Rowlandson, Ian; Xue, Joel; Clark, Elaine; Devine, Brian; Macfarlane, Peter; de Bie, Johan; Mortara, David; Babaeizadeh, Saeed; Gregg, Richard; Helfenbein, Eric D; Green, Cynthia L

2014-02-01

Automated measurements of electrocardiographic (ECG) intervals are widely used by clinicians for individual patient diagnosis and by investigators in population studies. We examined whether clinically significant systematic differences exist in ECG intervals measured by current generation digital electrocardiographs from different manufacturers and whether differences, if present, are dependent on the degree of abnormality of the selected ECGs. Measurements of RR interval, PR interval, QRS duration, and QT interval were made blindly by 4 major manufacturers of digital electrocardiographs used in the United States from 600 XML files of ECG tracings stored in the US FDA ECG warehouse and released for the purpose of this study by the Cardiac Safety Research Consortium. Included were 3 groups based on expected QT interval and degree of repolarization abnormality, comprising 200 ECGs each from (1) placebo or baseline study period in normal subjects during thorough QT studies, (2) peak moxifloxacin effect in otherwise normal subjects during thorough QT studies, and (3) patients with genotyped variants of congenital long QT syndrome (LQTS). Differences of means between manufacturers were generally small in the normal and moxifloxacin subjects, but in the LQTS patients, differences of means ranged from 2.0 to 14.0 ms for QRS duration and from 0.8 to 18.1 ms for the QT interval. Mean absolute differences between algorithms were similar for QRS duration and QT intervals in the normal and in the moxifloxacin subjects (mean ≤6 ms) but were significantly larger in patients with LQTS. Small but statistically significant group differences in mean interval and duration measurements and means of individual absolute differences exist among automated algorithms of widely used, current generation digital electrocardiographs. Measurement differences, including QRS duration and the QT interval, are greatest for the most abnormal ECGs. © 2014.

Functionalization of quantum rods with oligonucleotides for programmable assembly with DNA origami

NASA Astrophysics Data System (ADS)

Doane, Tennyson L.; Alam, Rabeka; Maye, Mathew M.

2015-02-01

The DNA-mediated self-assembly of CdSe/CdS quantum rods (QRs) onto DNA origami is described. Two QR types with unique optical emission and high polarization were synthesized, and then functionalized with oligonucleotides (ssDNA) using a novel protection-deprotection approach, which harnessed ssDNA's tailorable rigidity and denaturation temperature to increase DNA coverage by reducing non-specific coordination and wrapping. The QR assembly was programmable, and occurred at two different assembly zones that had capture strands in parallel alignment. QRs with different optical properties were assembled, opening up future studies on orientation dependent QR FRET. The QR-origami conjugates could be purified via gel electrophoresis and sucrose gradient ultracentrifugation. Assembly yields, QR stoichiometry and orientation, as well as energy transfer implications were studied in light of QR distances, origami flexibility, and conditions.The DNA-mediated self-assembly of CdSe/CdS quantum rods (QRs) onto DNA origami is described. Two QR types with unique optical emission and high polarization were synthesized, and then functionalized with oligonucleotides (ssDNA) using a novel protection-deprotection approach, which harnessed ssDNA's tailorable rigidity and denaturation temperature to increase DNA coverage by reducing non-specific coordination and wrapping. The QR assembly was programmable, and occurred at two different assembly zones that had capture strands in parallel alignment. QRs with different optical properties were assembled, opening up future studies on orientation dependent QR FRET. The QR-origami conjugates could be purified via gel electrophoresis and sucrose gradient ultracentrifugation. Assembly yields, QR stoichiometry and orientation, as well as energy transfer implications were studied in light of QR distances, origami flexibility, and conditions. Electronic supplementary information (ESI) available: Experimental conditions, DNA origami blueprint and sequences, FRET calculations. Additional Fig. S1-S13. See DOI: 10.1039/c4nr07662a

Variations of intrathoracic amount of blood as a reason of ECG voltage changes.

PubMed

Saltykova, Marina; Capderou, Andre; Atkov, Oleg; Gusakov, Victor; Konovalov, Gennagiy; Voronin, Leonid; Kaspranskiy, Rustem; Morgun, Valeriy; Bailliart, Olivier; Cermack, Milan; Vaïda, Pierre

2003-10-01

It is known that electroconduction of intrathoracic organs and tissues significantly influences the ECG voltage. It changes during therapy or exercise test due to redistribution and/or volume variations of blood and body fluids and their electroconductivity variations. This fact must be taken into consideration during interpretation of corresponding ECG. But there are no quantitative estimations of this influence on human ECG. The goals of this study were to estimate the influence of variations of thoracic electroconduction, and heart volume on QRS voltage in humans, due to gravity change. ECGs of 26 healthy volunteers were analyzed in upright and supine position. Experimental conditions-acute change of gravity--are created in a special aircraft flying on Kepler's parabola trajectory. Each parabola includes phases of normo-, hypergravity (blood shifts in caudal direction), and microgravity (blood redistributes in cranial direction). Amplitude of QRS in Frank leads in all phases has been analyzed. 2-D echo studies for six subjects were used for estimation of heart volume change. In an upright position during hypergravity the amplitude of R wave in Z increases in 95% of cases (mean 0.19 mV). During microgravity amplitude of R wave in Z decreases in 95% (mean 0.24 mV). In supine position changes of QRS voltage are not significantly. Blood redistribution during gravity change leads to changes of QRS voltage, which is more expressed and steady on R in Z lead: an average near 0.2 mV. It is due to the balance between two factors: (a). changes of degree of short circuiting by variations in the amount of blood in thorax (b). changes of distance between heart and electrodes as a result of change in the position, form, and volume of the heart.

Surface ECG and Fluoroscopy are Not Predictive of Right Ventricular Septal Lead Position Compared to Cardiac CT.

PubMed

Rowe, Matthew K; Moore, Peter; Pratap, Jit; Coucher, John; Gould, Paul A; Kaye, Gerald C

2017-05-01

Controversy exists regarding the optimal lead position for chronic right ventricular (RV) pacing. Placing a lead at the RV septum relies upon fluoroscopy assisted by a surface 12-lead electrocardiogram (ECG). We compared the postimplant lead position determined by ECG-gated multidetector contrast-enhanced computed tomography (MDCT) with the position derived from the surface 12-lead ECG. Eighteen patients with permanent RV leads were prospectively enrolled. Leads were placed in the RV septum (RVS) in 10 and the RV apex (RVA) in eight using fluoroscopy with anteroposterior and left anterior oblique 30° views. All patients underwent MDCT imaging and paced ECG analysis. ECG criteria were: QRS duration; QRS axis; positive or negative net QRS amplitude in leads I, aVL, V1, and V6; presence of notching in the inferior leads; and transition point in precordial leads at or after V4. Of the 10 leads implanted in the RVS, computed tomography (CT) imaging revealed seven to be at the anterior RV wall, two at the anteroseptal junction, and one in the true septum. For the eight RVA leads, four were anterior, two septal, and two anteroseptal. All leads implanted in the RVS met at least one ECG criteria (median 3, range 1-6). However, no criteria were specific for septal position as judged by MDCT. Mean QRS duration was 160 ± 24 ms in the RVS group compared with 168 ± 14 ms for RVA pacing (P = 0.38). We conclude that the surface ECG is not sufficiently accurate to determine RV septal lead tip position compared to cardiac CT. © 2017 Wiley Periodicals, Inc.

Differentiating fasciculoventricular pathway from Wolff-Parkinson-White syndrome by electrocardiography.

PubMed

Suzuki, Tsugutoshi; Nakamura, Yoshihide; Yoshida, Shuichiro; Yoshida, Yoko; Shintaku, Haruo

2014-04-01

In school-based cardiovascular screening programs in Japan, Wolff-Parkinson-White (WPW) syndrome is diagnosed based on the presence of an electrocardiographic (ECG) delta wave without differentiation from the fasciculoventricular pathway (FVP), although the risk of sudden death is associated only with the former. The purpose of this study was to differentiate FVP patients among children diagnosed with WPW syndrome by ECG. Children who were diagnosed with WPW syndrome through school screening between April 2006 and March 2008 and had QRS width ≤120 ms were included. Patients with asthma and/or coronary heart disease were excluded. FVP and WPW syndrome were differentiated based on ECG responses to adenosine triphosphate (ATP) injection. Age, PR interval, QRS width, and Rosenbaum classification were compared among patients. Thirty patients (median age 12.7 years, range 6.5-15.7 years) participated in the study. FVP was diagnosed in 23 patients (76.7%), and WPW syndrome in 7 (23.3%). In Rosenbaum type A patients, all six patients had WPW syndrome, whereas FVP was diagnosed in 23 of 24 and WPW syndrome was diagnosed in 1 of 24 of type B patients. Age, PR interval, and QRS width were not significantly different between the two conditions. ATP stress test was reliable in differentiating FVP from WPW syndrome. Although FVP is considered rare, the results of our study indicate that many WPW syndrome patients with QRS width ≤120 ms may actually have FVP. Patients categorized as type B are more likely to have FVP, whereas type A patients are most likely to have WPW syndrome. © 2013 Heart Rhythm Society Published by Heart Rhythm Society All rights reserved.

Electrocardiogram abnormalities and coronary calcification in postmenopausal women.

PubMed

Sabour, Siamak; Grobbee, Diederick; Rutten, Annemarieke; Prokop, Mathias; Bartelink, Marie-Louise; van der Schouw, Yvonne; Bots, Michiel

2010-01-01

An electrocardiogram (ECG) can provide information on subclinical myocardial damage. The presence, and more importantly, the quantity of coronary artery calcification (CAC), relates well with the overall severity of the atherosclerotic process. A strong relation has been demonstrated between coronary calcium burden and the incidence of myocardial infarction, a relation independent of age. The aim of this study was to assess the relation of left ventricular hypertrophy (LVH) and ECG abnormalities with CAC. The study population comprised 566 postmenopausal women selected from a population-based cohort study. Information on LVH and repolarization abnormalities (T-axis and QRS-T angle) was obtained using electrocardiography. Modular ECG Analysis System (MEANS) was used to assess ECG abnormalities. The women underwent a multi detector-row computed tomography (MDCT) scan (Philips Mx 8000 IDT 16) to assess CAC. The Agatston score was used to quantify CAC; scores greater than zero were considered as the presence of coronary calcium. Logistic regression was used to assess the relation of ECG abnormality with coronary calcification. LVH was found in 2.7% (n = 15) of the women. The prevalence of T-axis abnormality was 6% (n = 34), whereas 8.5% (n = 48) had a QRS-T angle abnormality. CAC was found in 62% of the women. Compared to women with a normal T-axis, women with borderline or abnormal T-axes were 3.8 fold more likely to have CAC (95% CI: 1.4-10.2). Similarly, compared to women with a normal QRS-T angle, in women with borderline or abnormal QRS-T angle, CAC was 2.0 fold more likely to be present (95% CI: 1.0-4.1). Among women with ECG abnormalities reflecting subclinical ischemia, CAC is commonly found and may in part explain the increased coronary heart disease risk associated with these ECG abnormalities.

Left ventricular hypertrophy: The relationship between the electrocardiogram and cardiovascular magnetic resonance imaging.

PubMed

Bacharova, Ljuba; Ugander, Martin

2014-11-01

Conventional assessment of left ventricular hypertrophy (LVH) using the electrocardiogram (ECG), for example, by the Sokolow-Lyon, Romhilt-Estes or Cornell criteria, have relied on assessing changes in the amplitude and/or duration of the QRS complex of the ECG to quantify LV mass. ECG measures of LV mass have typically been validated by imaging with echocardiography or cardiovascular magnetic resonance imaging (CMR). However, LVH can be the result of diverse etiologies, and LVH is also characterized by pathological changes in myocardial tissue characteristics on the genetic, molecular, cellular, and tissue level beyond a pure increase in the number of otherwise normal cardiomyocytes. For example, slowed conduction velocity through the myocardium, which can be due to diffuse myocardial fibrosis, has been shown to be an important determinant of conventional ECG LVH criteria regardless of LV mass. Myocardial tissue characterization by CMR has emerged to not only quantify LV mass, but also detect and quantify the extent and severity of focal or diffuse myocardial fibrosis, edema, inflammation, myocarditis, fatty replacement, myocardial disarray, and myocardial deposition of amyloid proteins (amyloidosis), glycolipids (Fabry disease), or iron (siderosis). This can be undertaken using CMR techniques including late gadolinium enhancement (LGE), T1 mapping, T2 mapping, T2* mapping, extracellular volume fraction (ECV) mapping, fat/water-weighted imaging, and diffusion tensor CMR. This review presents an overview of current and emerging concepts regarding the diagnostic possibilities of both ECG and CMR for LVH in an attempt to narrow gaps in our knowledge regarding the ECG diagnosis of LVH. © 2014 Wiley Periodicals, Inc.

Numerically exploring habitat fragmentation effects on populations using cell-based coupled map lattices

Treesearch

Michael Bevers; Curtis H. Flather

1999-01-01

We examine habitat size, shape, and arrangement effects on populations using a discrete reaction-diffusion model. Diffusion is modeled passively and applied to a cellular grid of territories forming a coupled map lattice. Dispersal mortality is proportional to the amount of nonhabitat and fully occupied habitat surrounding a given cell, with distance decay. After...

Stream computing for biomedical signal processing: A QRS complex detection case-study.

PubMed

Murphy, B M; O'Driscoll, C; Boylan, G B; Lightbody, G; Marnane, W P

2015-01-01

Recent developments in "Big Data" have brought significant gains in the ability to process large amounts of data on commodity server hardware. Stream computing is a relatively new paradigm in this area, addressing the need to process data in real time with very low latency. While this approach has been developed for dealing with large scale data from the world of business, security and finance, there is a natural overlap with clinical needs for physiological signal processing. In this work we present a case study of streams processing applied to a typical physiological signal processing problem: QRS detection from ECG data.

Analysis of QRS loop changes in the beat-to-beat Vectocardiogram of ischemic patients undergoing PTCA.

PubMed

Correa, Raul; Laciar, Eric; Arini, Pedro; Jane, Raimon

2009-01-01

In the present work, we have studied dynamic changes of QRS loop in the Vectocardiogram (VCG) of 80 patients that underwent Percutaneous Transluminal Coronary Angioplasty (PTCA). The VCG was obtained for each patient using the XYZ orthogonal leads of their electrocardiographic (ECG) records acquired before, during and after PTCA procedure. In order to analyze the variations of VCG, it has been proposed in this study the following parameters a) Maximum module of the cardiac depolarization vector, b) Volume, c) and Area of vectocardiographic loop corresponding to the QRS complex of each beat, d) Maximum distance between Centroid and the Loop, e) Angle between the XY plane and the Optimum Plane, f) Relation between the Area and Perimeter. The results obtained indicate that the parameters proposed show significant statistics differences (p-value<0.05) before, during (with some exceptions at the first minute of balloon inflation) and after PTCA. We conclude that the variations observed in the proposed parameters correctly represent not only the morphological changes in the depolarization VCG but also they reflect the modifications in the levels of cardiac ischemia induced by PTCA.

QRS detection based ECG quality assessment.

PubMed

Hayn, Dieter; Jammerbund, Bernhard; Schreier, Günter

2012-09-01

Although immediate feedback concerning ECG signal quality during recording is useful, up to now not much literature describing quality measures is available. We have implemented and evaluated four ECG quality measures. Empty lead criterion (A), spike detection criterion (B) and lead crossing point criterion (C) were calculated from basic signal properties. Measure D quantified the robustness of QRS detection when applied to the signal. An advanced Matlab-based algorithm combining all four measures and a simplified algorithm for Android platforms, excluding measure D, were developed. Both algorithms were evaluated by taking part in the Computing in Cardiology Challenge 2011. Each measure's accuracy and computing time was evaluated separately. During the challenge, the advanced algorithm correctly classified 93.3% of the ECGs in the training-set and 91.6 % in the test-set. Scores for the simplified algorithm were 0.834 in event 2 and 0.873 in event 3. Computing time for measure D was almost five times higher than for other measures. Required accuracy levels depend on the application and are related to computing time. While our simplified algorithm may be accurate for real-time feedback during ECG self-recordings, QRS detection based measures can further increase the performance if sufficient computing power is available.

Optoelectronics of inverted type-I CdS/CdSe core/crown quantum ring

NASA Astrophysics Data System (ADS)

Bose, Sumanta; Fan, Weijun; Zhang, Dao Hua

2017-10-01

Inverted type-I heterostructure core/crown quantum rings (QRs) are quantum-efficient luminophores, whose spectral characteristics are highly tunable. Here, we study the optoelectronic properties of type-I core/crown CdS/CdSe QRs in the zincblende phase—over contrasting lateral size and crown width. For this, we inspect their strain profiles, transition energies, transition matrix elements, spatial charge densities, electronic bandstructures, band-mixing probabilities, optical gain spectra, maximum optical gains, and differential optical gains. Our framework uses an effective-mass envelope function theory based on the 8-band k ṡ p method employing the valence force field model for calculating the atomic strain distributions. The gain calculations are based on the density-matrix equation and take into consideration the excitonic effects with intraband scattering. Variations in the QR lateral size and relative widths of core and crown (ergo the composition) affect their energy levels, band-mixing probabilities, optical transition matrix elements, emission wavelengths/intensities, etc. The optical gain of QRs is also strongly dimension and composition dependent with further dependency on the injection carrier density causing the band-filling effect. They also affect the maximum and differential gain at varying dimensions and compositions.

Optical characterization of type-I to type-II band alignment transition in GaAs/Al x Ga1-x As quantum rings grown by droplet epitaxy

NASA Astrophysics Data System (ADS)

Su, Linlin; Wang, Ying; Guo, Qinglin; Li, Xiaowei; Wang, Shufang; Fu, Guangsheng; Mazur, Yuriy I.; E Ware, Morgan; Salamo, Gregory J.; Liang, Baolai; Huffaker, Diana L.

2017-08-01

Optical properties of GaAs/Al x Ga1-x As quantum rings (QRs) grown on GaAs (1 0 0) by droplet epitaxy have been investigated as a function of the Al-composition in the Al x Ga1-x As barrier. A transition from type-I to type-II band alignment is observed for the QRs via photoluminescence (PL) and time-resolved photoluminescence (TRPL) measurements. While x  ⩽  0.45, the QR PL spectra show a blue-shift and an increasing intensity with increasing Al-composition, revealing the enhancement of quantum confinement in the QRs with type-I band alignment. While x  ⩾  0.60, the characteristic large blue-shift with excitation intensity and the much longer lifetime indicate the realization of a type-II band alignment. Due to the height fluctuation of QR structures grown by droplet epitaxy mode, it is not the large blue-shift of emission energy, but the long lifetime that becomes the more important feature to identify the type-II band alignment.

Tissue Doppler Imaging Combined with Advanced 12-Lead ECG Analysis Might Improve Early Diagnosis of Hypertrophic Cardiomyopathy in Childhood

NASA Technical Reports Server (NTRS)

Femlund, E.; Schlegel, T.; Liuba, P.

2011-01-01

Optimization of early diagnosis of childhood hypertrophic cardiomyopathy (HCM) is essential in lowering the risk of HCM complications. Standard echocardiography (ECHO) has shown to be less sensitive in this regard. In this study, we sought to assess whether spatial QRS-T angle deviation, which has shown to predict HCM in adults with high sensitivity, and myocardial Tissue Doppler Imaging (TDI) could be additional tools in early diagnosis of HCM in childhood. Methods: Children and adolescents with familial HCM (n=10, median age 16, range 5-27 years), and without obvious hypertrophy but with heredity for HCM (n=12, median age 16, range 4-25 years, HCM or sudden death with autopsy-verified HCM in greater than or equal to 1 first-degree relative, HCM-risk) were additionally investigated with TDI and advanced 12-lead ECG analysis using Cardiax(Registered trademark) (IMED Co Ltd, Budapest, Hungary and Houston). Spatial QRS-T angle (SA) was derived from Kors regression-related transformation. Healthy age-matched controls (n=21) were also studied. All participants underwent thorough clinical examination. Results: Spatial QRS-T angle (Figure/ Panel A) and septal E/Ea ratio (Figure/Panel B) were most increased in HCM group as compared to the HCM-risk and control groups (p less than 0.05). Of note, these 2 variables showed a trend toward higher levels in HCM-risk group than in control group (p=0.05 for E/Ea and 0.06 for QRS/T by ANOVA). In a logistic regression model, increased SA and septal E/Ea ratio appeared to significantly predict both the disease (Chi-square in HCM group: 9 and 5, respectively, p less than 0.05 for both) and the risk for HCM (Chi-square in HCM-risk group: 5 and 4 respectively, p less than 0.05 for both), with further increased predictability level when these 2 variables were combined (Chi-square 10 in HCM group, and 7 in HCM-risk group, p less than 0.01 for both). Conclusions: In this small material, Tissue Doppler Imaging and spatial mean QRS-T angle deviation, particularly when combined, appear to be sensitive in predicting the risk for developing childhood HCM. Large-scale, prospective studies are needed to confirm this hypothesis.

Perspectives of human verification via binary QRS template matching of single-lead and 12-lead electrocardiogram.

PubMed

Krasteva, Vessela; Jekova, Irena; Schmid, Ramun

2018-01-01

This study aims to validate the 12-lead electrocardiogram (ECG) as a biometric modality based on two straightforward binary QRS template matching characteristics. Different perspectives of the human verification problem are considered, regarding the optimal lead selection and stability over sample size, gender, age, heart rate (HR). A clinical 12-lead resting ECG database, including a population of 460 subjects with two-session recordings (>1 year apart) is used. Cost-effective strategies for extraction of personalized QRS patterns (100ms) and binary template matching estimate similarity in the time scale (matching time) and dissimilarity in the amplitude scale (mismatch area). The two-class person verification task, taking the decision to validate or to reject the subject identity is managed by linear discriminant analysis (LDA). Non-redundant LDA models for different lead configurations (I,II,III,aVF,aVL,aVF,V1-V6) are trained on the first half of 230 subjects by stepwise feature selection until maximization of the area under the receiver operating characteristic curve (ROC AUC). The operating point on the training ROC at equal error rate (EER) is tested on the independent dataset (second half of 230 subjects) to report unbiased validation of test-ROC AUC and true verification rate (TVR = 100-EER). The test results are further evaluated in groups by sample size, gender, age, HR. The optimal QRS pattern projection for single-lead ECG biometric modality is found in the frontal plane sector (60°-0°) with best (Test-AUC/TVR) for lead II (0.941/86.8%) and slight accuracy drop for -aVR (-0.017/-1.4%), I (-0.01/-1.5%). Chest ECG leads have degrading accuracy from V1 (0.885/80.6%) to V6 (0.799/71.8%). The multi-lead ECG improves verification: 6-chest (0.97/90.9%), 6-limb (0.986/94.3%), 12-leads (0.995/97.5%). The QRS pattern matching model shows stable performance for verification of 10 to 230 individuals; insignificant degradation of TVR in women by (1.2-3.6%), adults ≥70 years (3.7%), younger <40 years (1.9%), HR<60bpm (1.2%), HR>90bpm (3.9%), no degradation for HR change (0 to >20bpm).

Multinucleon transfer in central collisions of 238U+238U

NASA Astrophysics Data System (ADS)

Ayik, S.; Yilmaz, B.; Yilmaz, O.; Umar, A. S.; Turan, G.

2017-08-01

Quantal diffusion mechanism of nucleon exchange is studied in the central collisions of 238U+238U in the framework of the stochastic mean-field (SMF) approach. For bombarding energies considered in this work, the dinuclear structure is maintained during the collision. Hence, it is possible to describe nucleon exchange as a diffusion process for mass and charge asymmetry. Quantal neutron and proton diffusion coefficients, including memory effects, are extracted from the SMF approach and the primary fragment distributions are calculated.

Room-temperature ballistic energy transport in molecules with repeating units

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rubtsova, Natalia I.; Nyby, Clara M.; Zhang, Hong

2015-06-07

In materials, energy can propagate by means of two limiting regimes: diffusive and ballistic. Ballistic energy transport can be fast and efficient and often occurs with a constant speed. Using two-dimensional infrared spectroscopy methods, we discovered ballistic energy transport via individual polyethylene chains with a remarkably high speed of 1440 m/s and the mean free path length of 14.6 Å in solution at room temperature. Whereas the transport via the chains occurs ballistically, the mechanism switches to diffusive with the effective transport speed of 130 m/s at the end-groups attached to the chains. A unifying model of the transport inmore » molecules is presented with clear time separation and additivity among the transport along oligomeric fragments, which occurs ballistically, and the transport within the disordered fragments, occurring diffusively. The results open new avenues for making novel elements for molecular electronics, including ultrafast energy transporters, controlled chemical reactors, and sub-wavelength quantum nanoseparators.« less

Scleroderma Autoantigens Are Uniquely Fragmented by Metal-catalyzed Oxidation Reactions: Implications for Pathogenesis

PubMed Central

Casciola-Rosen, Livia; Wigley, Fredrick; Rosen, Antony

1997-01-01

The observation that revelation of immunocryptic epitopes in self antigens may initiate the autoimmune response has prompted the search for processes which induce novel fragmentation of autoantigens as potential initiators of autoimmunity. The reversible ischemia reperfusion which characterizes scleroderma has focused attention on reactive oxygen species as molecules which might induce autoantigen fragmentation. We demonstrate that several of the autoantigens targeted in diffuse scleroderma are uniquely susceptible to cleavage by reactive oxygen species, in a metal-dependent manner. Multiple features of the fragmentation reaction and its inhibition indicate that these autoantigens possess metal-binding sites, which focus metal-catalyzed oxidation reactions (and consequent fragmentation) to specific regions of the antigens. These data suggest that the autoantibody response in scleroderma is the immune marker of unique protein fragmentation, induced by ischemia reperfusion in the presence of appropriate metals, and focus attention on abnormal metal status as a potential pathogenic principle in this disease. PMID:8996243

Late Gadolinium Enhancement Amount As an Independent Risk Factor for the Incidence of Adverse Cardiovascular Events in Patients with Stage C or D Heart Failure

PubMed Central

Liu, Tong; Ma, Xiaohai; Liu, Wei; Ling, Shukuan; Zhao, Lei; Xu, Lei; Song, Deli; Liu, Jie; Sun, Zhonghua; Fan, Zhanming; Luo, Taiyang; Kang, Junping; Liu, Xiaohui; Dong, Jianzeng

2016-01-01

Background: Myocardial fibrosis (MF) is a risk factor for poor prognosis in dilated cardiomyopathy (DCM). Late gadolinium enhancement (LGE) of the myocardium on cardiac magnetic resonance (CMR) represents MF. We examined whether the LGE amount increases the incidence of adverse cardiovascular events in patients with stage C or D heart failure (HF). Methods: Eighty-four consecutive patients with stage C or D HF, either ischemic or non-ischemic, were enrolled. Comprehensive clinical and CMR evaluations were performed. All patients were followed up for a composite endpoint of cardiovascular death, heart transplantation, and cardiac resynchronization therapy with defibrillator (CRT-D). Results: LGE was present in 79.7% of the end-stage HF patients. LGE distribution patterns were mid-wall, epi-myocardial, endo-myocardial, and the morphological patterns were patchy, transmural, and diffuse. During the average follow-up of 544 days, 13 (15.5%) patients had endpoint events: 7 patients cardiac death, 2 patients heart transplantation, and 4 patients underwent CRT-D implantation. On univariate analysis, LGE quantification on cardiac magnetic resonance, blood urine nitrogen, QRS duration on electrocardiogram, left ventricular end-diastolic diameter (LVEDD), and left ventricular end-diastolic volume (LVEDV) on CMR had the strongest associations with the composite endpoint events. However, on multivariate analysis for both Model I (after adjusting for age, sex, and body mass index) and Model II (after adjusting for age, sex, BMI, renal function, QRS duration, and atrial fibrillation on electrocardiogram, the etiology of HF, LVEF, CMR-LVEDD, and CMR-LVEDV), LGE amount was a significant risk factor for composite endpoint events (Model I 6SD HR 1.037, 95%CI 1.005–1.071, p = 0.022; Model II 6SD HR 1.045, 95%CI 1.001–1.084, p = 0.022). Conclusion: LGE amount from high-scale threshold on CMR increased the incidence of adverse cardiovascular events for patients in either stage C or D HF. PMID:27840608

Diffusion-driven magnesium and iron isotope fractionation in Hawaiian olivine

USGS Publications Warehouse

Teng, F.-Z.; Dauphas, N.; Helz, R.T.; Gao, S.; Huang, S.

2011-01-01

Diffusion plays an important role in Earth sciences to estimate the timescales of geological processes such as erosion, sediment burial, and magma cooling. In igneous systems, these diffusive processes are recorded in the form of crystal zoning. However, meaningful interpretation of these signatures is often hampered by the fact that they cannot be unambiguously ascribed to a single process (e.g., magmatic fractionation, diffusion limited transport in the crystal or in the liquid). Here we show that Mg and Fe isotope fractionations in olivine crystals can be used to trace diffusive processes in magmatic systems. Over sixty olivine fragments from Hawaiian basalts show isotopically fractionated Mg and Fe relative to basalts worldwide, with up to 0.4??? variation in 26Mg/24Mg ratios and 1.6??? variation in 56Fe/54Fe ratios. The linearly and negatively correlated Mg and Fe isotopic compositions [i.e., ??56Fe=(??3.3??0.3)????26Mg], co-variations of Mg and Fe isotopic compositions with Fe/Mg ratios of olivine fragments, and modeling results based on Mg and Fe elemental profiles demonstrate the coupled Mg and Fe isotope fractionation to be a manifestation of Mg-Fe inter-diffusion in zoned olivines during magmatic differentiation. This characteristic can be used to constrain the nature of mineral zoning in igneous and metamorphic rocks, and hence determine the residence times of crystals in magmas, the composition of primary melts, and the duration of metamorphic events. With improvements in methodology, in situ isotope mapping will become an essential tool of petrology to identify diffusion in crystals. ?? 2011 Elsevier B.V.

Bicarbonate refractory QRS prolongation and left bundle-branch block following escitalopram and lamotrigine overdose: A case report and literature review of toxic left bundle-branch block.

PubMed

Farkas, A N; Marcott, M; Yanta, J H; Pizon, A F

2018-05-02

Toxic prolongation of the QRS interval most often results from blockade of cardiac voltage-gated sodium channels and manifests on electrocardiogram with a right bundle-branch block-like morphology. Rarely, a left bundle-branch block (LBBB) morphology has been reported. We report a case of transient LBBB resultant from ingestion of lamotrigine and citalopram which was refractory to sodium bicarbonate therapy and eventually resolved spontaneously. Cases of toxic LBBB are less likely to respond to bicarbonate therapy, suggesting that this finding is due to a mechanism other than sodium channel blockade. © 2018 John Wiley & Sons Ltd.

Rapid recovery from congestive heart failure following successful radiofrequency catheter ablation in a patient with late onset of Wolff-Parkinson-White syndrome.

PubMed

Yodogawa, Kenji; Ono, Norihiko; Seino, Yoshihiko

2012-01-01

A 56-year-old man was admitted because of palpitations and dyspnea. A 12-lead electrocardiogram showed irregular wide QRS complex tachycardia with a slur at the initial portion of the QRS complex. He had preexisting long-standing persistent atrial fibrillation, but early excitation syndrome had never been noted. Chest X-ray showed heart enlargement and pulmonary congestion. He was diagnosed with late onset of Wolff-Parkinson-White syndrome, and congestive heart failure was probably caused by rapid ventricular response of atrial fibrillation through the accessory pathway. Emergency catheter ablation for the accessory pathway was undertaken, and heart failure was dramatically improved.

Quantal diffusion description of multinucleon transfers in heavy-ion collisions

NASA Astrophysics Data System (ADS)

Ayik, S.; Yilmaz, B.; Yilmaz, O.; Umar, A. S.

2018-05-01

Employing the stochastic mean-field (SMF) approach, we develop a quantal diffusion description of the multi-nucleon transfer in heavy-ion collisions at finite impact parameters. The quantal transport coefficients are determined by the occupied single-particle wave functions of the time-dependent Hartree-Fock equations. As a result, the primary fragment mass and charge distribution functions are determined entirely in terms of the mean-field properties. This powerful description does not involve any adjustable parameter, includes the effects of shell structure, and is consistent with the fluctuation-dissipation theorem of the nonequilibrium statistical mechanics. As a first application of the approach, we analyze the fragment mass distribution in 48Ca+ 238U collisions at the center-of-mass energy Ec.m.=193 MeV and compare the calculations with the experimental data.

A STUDY OF MEIOSIS IN THE PROGENY OF X-IRRADIATED LUZULA PURPUREA

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nordenskiold, H.

1963-01-01

In Luzula the chromosomes have diffuse or nonlocalized centromeres; thus, if the chromosomes are broken or rearranged by x-ray treatment, the changed chromosome patterns may survive through the mitotic cell divisions, on account of the centromeric action along the whole chromosomes. Hence, such plants with diffuse centromeres are able to survive and reach adult stages in spite of the fact that their chromosomes have been rearranged or broken by x-ray treatment of the seedlings. A study was made of plants selected from the progeny of material treated as seedlings with 1000 or 2500 r. Plants treated with stronger doses (5000more » to 10000 r) were almost or completely sterile. The chromosome patterns of the root tips of X/sub 2/ plants were investigated in order to find plants with desirable chrom-osome patterns for the meiotic investigation. The x-irradiated plants themselves showed intricate metaphasic configurations during meiosis. The separation of the multi-associations at first anaphase is cytologically equational, and in most cases without bridges. Migration of chromatids during second anaphase is also regular without lagging chromosomes, but chromosome sets of 4 tetrad cells usually become unbalanced, causing reduced fertility. The mitotic chromosome patterns of X/sub 2/ plants showed three categories of patterns: 2n = 6; most of these plants have all chromosomes the same size, but some of them possess one long and one short chromosome indicating a reciprocal translocation between two chromosomes; 2n = 7, with one of the original chromosomes fragmented into two pieces; and 2n = 8, with two of the original chromosomes fragmented into two pieces each. A study was made of meiosis in X/ sub 2/ plants with a cytologically observable rearrangement in the root tips, determined as a reciprocal progeny plants were obtained. Meiosis of X/sub 2/ plants heterozygous for one chromosome fragmented into two pieces, i.e., possessing 2n = 7 with five normal-sized and two small half-sized chromosomes, was also studied. The expected course of meiosis was realized, giving rise to four balanced chromosome sets of the tetrads, two of them containing three normal- sized chromosomes and the remaining two having two normal-sized and two half- sized ones. These studied plants were all fertile. Examination of somatic chromosome patterns of the progenies originating from the X/sub 2/ plants heterozygous for one fragmented chromosome revealed the three expected chromosome patterns, i.e., 2n =6, 2n =7, 2n =8. X/sub 2/ plants with 2n =8 were homozygous for the fragmented chromosome, and had a completely regular meiosis with two large and two small bivalents during first metaphase and a regular pairing and separation during the second division. Consequently they gave rise to a fertile strain with a constart chromosome pattern. The origin of the aneuploidy and endonuclear polyploidy of material with diffuse centromeres was discussed in relation to the survival of the fragmented chromosomes in L. purpurea. The survival of broken chromosomes through consecutive generations thus gives an explanation of the occurrence of aneuploid chromosome numbers in material with diffuse centromeres. However, no interpretation of the phenomenon causing the survival of the fragments was provided by this study, since sufficient knowledge about the nature of the diffuse or nonlocalized centromeres is unavailable. (BBB)« less

An Energy efficient application specific integrated circuit for electrocardiogram feature detection and its potential for ambulatory cardiovascular disease detection

PubMed Central

Bhaumik, Basabi

2016-01-01

A novel algorithm based on forward search is developed for real-time electrocardiogram (ECG) signal processing and implemented in application specific integrated circuit (ASIC) for QRS complex related cardiovascular disease diagnosis. The authors have evaluated their algorithm using MIT-BIH database and achieve sensitivity of 99.86% and specificity of 99.93% for QRS complex peak detection. In this Letter, Physionet PTB diagnostic ECG database is used for QRS complex related disease detection. An ASIC for cardiovascular disease detection is fabricated using 130-nm CMOS high-speed process technology. The area of the ASIC is 0.5 mm2. The power dissipation is 1.73 μW at the operating frequency of 1 kHz with a supply voltage of 0.6 V. The output from the ASIC is fed to their Android application that generates diagnostic report and can be sent to a cardiologist through email. Their ASIC result shows average failed detection rate of 0.16% for six leads data of 290 patients in PTB diagnostic ECG database. They also have implemented a low-leakage version of their ASIC. The ASIC dissipates only 45 pJ with a supply voltage of 0.9 V. Their proposed ASIC is most suitable for energy efficient telemetry cardiovascular disease detection system. PMID:27284458

Probing Bioluminescence Resonance Energy Transfer in Quantum Rod-Luciferase Nanoconjugates.

PubMed

Alam, Rabeka; Karam, Liliana M; Doane, Tennyson L; Coopersmith, Kaitlin; Fontaine, Danielle M; Branchini, Bruce R; Maye, Mathew M

2016-02-23

We describe the necessary design criteria to create highly efficient energy transfer conjugates containing luciferase enzymes derived from Photinus pyralis (Ppy) and semiconductor quantum rods (QRs) with rod-in-rod (r/r) microstructure. By fine-tuning the synthetic conditions, CdSe/CdS r/r-QRs were prepared with two different emission colors and three different aspect ratios (l/w) each. These were hybridized with blue, green, and red emitting Ppy, leading to a number of new BRET nanoconjugates. Measurements of the emission BRET ratio (BR) indicate that the resulting energy transfer is highly dependent on QR energy accepting properties, which include absorption, quantum yield, and optical anisotropy, as well as its morphological and topological properties, such as aspect ratio and defect concentration. The highest BR was found using r/r-QRs with lower l/w that were conjugated with red Ppy, which may be activating one of the anisotropic CdSe core energy levels. The role QR surface defects play on Ppy binding, and energy transfer was studied by growth of gold nanoparticles at the defects, which indicated that each QR set has different sites. The Ppy binding at those sites is suggested by the observed BRET red-shift as a function of Ppy-to-QR loading (L), where the lowest L results in highest efficiency and furthest shift.

Matched Filtering for Heart Rate Estimation on Compressive Sensing ECG Measurements.

PubMed

Da Poian, Giulia; Rozell, Christopher J; Bernardini, Riccardo; Rinaldo, Roberto; Clifford, Gari D

2017-09-14

Compressive Sensing (CS) has recently been applied as a low complexity compression framework for long-term monitoring of electrocardiogram signals using Wireless Body Sensor Networks. Long-term recording of ECG signals can be useful for diagnostic purposes and to monitor the evolution of several widespread diseases. In particular, beat to beat intervals provide important clinical information, and these can be derived from the ECG signal by computing the distance between QRS complexes (R-peaks). Numerous methods for R-peak detection are available for uncompressed ECG. However, in case of compressed sensed data, signal reconstruction can be performed with relatively complex optimisation algorithms, which may require significant energy consumption. This article addresses the problem of hearth rate estimation from compressive sensing electrocardiogram (ECG) recordings, avoiding the reconstruction of the entire signal. We consider a framework where the ECG signals are represented under the form of CS linear measurements. The QRS locations are estimated in the compressed domain by computing the correlation of the compressed ECG and a known QRS template. Experiments on actual ECG signals show that our novel solution is competitive with methods applied to the reconstructed signals. Avoiding the reconstruction procedure, the proposed method proves to be very convenient for real-time, low-power applications.

An Energy efficient application specific integrated circuit for electrocardiogram feature detection and its potential for ambulatory cardiovascular disease detection.

PubMed

Jain, Sanjeev Kumar; Bhaumik, Basabi

2016-03-01

A novel algorithm based on forward search is developed for real-time electrocardiogram (ECG) signal processing and implemented in application specific integrated circuit (ASIC) for QRS complex related cardiovascular disease diagnosis. The authors have evaluated their algorithm using MIT-BIH database and achieve sensitivity of 99.86% and specificity of 99.93% for QRS complex peak detection. In this Letter, Physionet PTB diagnostic ECG database is used for QRS complex related disease detection. An ASIC for cardiovascular disease detection is fabricated using 130-nm CMOS high-speed process technology. The area of the ASIC is 0.5 mm(2). The power dissipation is 1.73 μW at the operating frequency of 1 kHz with a supply voltage of 0.6 V. The output from the ASIC is fed to their Android application that generates diagnostic report and can be sent to a cardiologist through email. Their ASIC result shows average failed detection rate of 0.16% for six leads data of 290 patients in PTB diagnostic ECG database. They also have implemented a low-leakage version of their ASIC. The ASIC dissipates only 45 pJ with a supply voltage of 0.9 V. Their proposed ASIC is most suitable for energy efficient telemetry cardiovascular disease detection system.

Development and significance of a fetal electrocardiogram recorded by signal-averaged high-amplification electrocardiography.

PubMed

Hayashi, Risa; Nakai, Kenji; Fukushima, Akimune; Itoh, Manabu; Sugiyama, Toru

2009-03-01

Although ultrasonic diagnostic imaging and fetal heart monitors have undergone great technological improvements, the development and use of fetal electrocardiograms to evaluate fetal arrhythmias and autonomic nervous activity have not been fully established. We verified the clinical significance of the novel signal-averaged vector-projected high amplification ECG (SAVP-ECG) method in fetuses from 48 gravidas at 32-41 weeks of gestation and in 34 neonates. SAVP-ECGs from fetuses and newborns were recorded using a modified XYZ-leads system. Once noise and maternal QRS waves were removed, the P, QRS, and T wave intervals were measured from the signal-averaged fetal ECGs. We also compared fetal and neonatal heart rates (HRs), coefficients of variation of heart rate variability (CV) as a parasympathetic nervous activity, and the ratio of low to high frequency (LF/HF ratio) as a sympathetic nervous activity. The rate of detection of a fetal ECG by SAVP-ECG was 72.9%, and the fetal and neonatal QRS and QTc intervals were not significantly different. The neonatal CVs and LF/HF ratios were significantly increased compared with those in the fetus. In conclusion, we have developed a fetal ECG recording method using the SAVP-ECG system, which we used to evaluate autonomic nervous system development.

A rash with a heavy heart

PubMed Central

Barros-Gomes, Sergio; Naksuk, Niyada; Jevremovic, Dragan

2017-01-01

Cardiac amyloidosis (CA) is relatively rare and frequently misdiagnosed. Other disorders presenting with increased left ventricular (LV) mass can mimic its diagnosis. This case illustrates unique findings of primary light chain (AL) amyloidosis in a patient with remarkable signs of CA. Here, we report a 49-year-old male with prior diagnosis of hypertrophic cardiomyopathy (HCM) based on an echocardiogram performed 1 year earlier, which presented with 8 weeks of periorbital rash. The patient had numbness in the past 3 years. More recently, the patient presented with shortness of breath. Physical examination was remarkable for periorbital purpura, macroglossia and orthostatic hypotension. Cardiac auscultation showed S3 and S4. Electrocardiography showed diffuse low-voltage QRS complexes. Echocardiography revealed severe diastolic impairment; granular ‘sparkling’ pattern of the myocardium with thickened walls, interatrial septum and valves; and pericardial effusion. Diastolic dysfunction and thick walls with low ECG voltage are compelling diagnostic findings. Laboratory workup showed increased free light chain-differential (FLC-diff), N-terminal fragment of brain natriuretic peptide (NT-BNP) and cardiac Troponin T (cTnT). Bone marrow biopsy confirmed AL amyloidosis. A diagnosis of AL amyloidosis with cardiac involvement mimicking HCM was made. The patient died during hospitalization due to sudden cardiac death. This case illustrates the importance of the combination of clinical, serological, and electro- and echocardiographic findings to establish the diagnosis of CA. Learning points: Several disorders presenting with increased LV mass can mimic CA. Echocardiography is one of the most important methods to diagnose CA and HCM. Signs of CA include LV wall thickness; thickening of interatrial septum, valves and right ventricular free wall; and pericardial effusion. Diastolic dysfunction and thick walls on echocardiography with low ECG voltage are the hallmark of disease. CA is a major prognostic factor in AL amyloidosis. Signs of HCM on echocardiography include several patterns of LV hypertrophy, such as sigmoidal, reverse curve, neutral and apical morphologies; LV outflow tract or mid-cavity obstruction; systolic anterior motion of mitral leaflets; mitral regurgitation and diastolic dysfunction. The combination of clinical and serological features, along morphological and functional structures, has an important role for establishing diagnosis and predicting prognosis. PMID:28687586

Association between Latest Activated Sites in the Left Ventricle and Akinetic Segments in Patients with Ischemic Cardiomyopathy.

PubMed

Sadeghian, Hakimeh; Kousari, Aliasghar; Majidi, Shahla; Rezvanfard, Mehrnaz; Kazemisaeid, Ali; Moezzi, Seyed Ali; Vasheghani Farahani, Ali; Abdar Esfahani, Morteza; Sahebjam, Mohammad; Zoroufian, Arezoo; Sadeghian, Afsaneh

2016-07-06

Background: It is not clear whether the latest activation sites in the left ventricle (LV) are matched with infracted regions in patients with ischemic cardiomyopathy (ICM). We aimed to investigate whether the latest activation sites in the LV are in agreement with the region of akinesia in patients with ICM. Methods: Data were analyzed in 106 patients (age = 60.5 ± 12.1 y, male = 88.7%) with ICM (ejection fraction ≤ 35%) who were refractory to pharmacological therapy and were referred to the echocardiography department for an evaluation of the feasibility of cardiac resynchronization therapy. Wall motion abnormalities, time to peak systolic myocardial velocity (Ts) of 6 basal and 6 mid-portion segments of the LV, and 4 frequently used dyssynchrony indices were measured using 2-dimensional echocardiography and tissue Doppler imaging (TDI). To evaluate the influence of the electrocardiographic pattern, we categorized the patients into 2 groups: patients with QRS ≤ 120 ms and those with QRS >120 ms. Results: A total of 1 272 segments were studied. The latest activation sites (with longest Ts) were most frequently located in the mid-anterior (n = 32, 30.2%) and basal-anterior segments (n = 29, 27.4%), while the most common sites of akinesia were the mid-anteroseptal (n = 65, 61.3%) and mid-septal (n = 51, 48.1%) segments. Generally, no significant concordance was found between the latest activated segments and akinesia either in all the patients or in the QRS groups. Detailed analysis within the segments indicated a good agreement between akinesia and delayed activation in the basal-lateral segment solely in the patients with QRS duration ≤ 120 ms (Φ = 0.707; p value ≤ 0.001). Conclusion: The akinetic segment on 2-dimensional echocardiogram was not matched with the latest activation sites in the LV determined by TDI in patients with ICM.

Association between Latest Activated Sites in the Left Ventricle and Akinetic Segments in Patients with Ischemic Cardiomyopathy

PubMed Central

Sadeghian, Hakimeh; Kousari, Aliasghar; Majidi, Shahla; Rezvanfard, Mehrnaz; Kazemisaeid, Ali; Moezzi, Seyed Ali; Vasheghani Farahani, Ali; Abdar Esfahani, Morteza; Sahebjam, Mohammad; Zoroufian, Arezoo; Sadeghian, Afsaneh

2016-01-01

Background: It is not clear whether the latest activation sites in the left ventricle (LV) are matched with infracted regions in patients with ischemic cardiomyopathy (ICM). We aimed to investigate whether the latest activation sites in the LV are in agreement with the region of akinesia in patients with ICM. Methods: Data were analyzed in 106 patients (age = 60.5 ± 12.1 y, male = 88.7%) with ICM (ejection fraction ≤ 35%) who were refractory to pharmacological therapy and were referred to the echocardiography department for an evaluation of the feasibility of cardiac resynchronization therapy. Wall motion abnormalities, time to peak systolic myocardial velocity (Ts) of 6 basal and 6 mid-portion segments of the LV, and 4 frequently used dyssynchrony indices were measured using 2-dimensional echocardiography and tissue Doppler imaging (TDI). To evaluate the influence of the electrocardiographic pattern, we categorized the patients into 2 groups: patients with QRS ≤ 120 ms and those with QRS >120 ms. Results: A total of 1 272 segments were studied. The latest activation sites (with longest Ts) were most frequently located in the mid-anterior (n = 32, 30.2%) and basal-anterior segments (n = 29, 27.4%), while the most common sites of akinesia were the mid-anteroseptal (n = 65, 61.3%) and mid-septal (n = 51, 48.1%) segments. Generally, no significant concordance was found between the latest activated segments and akinesia either in all the patients or in the QRS groups. Detailed analysis within the segments indicated a good agreement between akinesia and delayed activation in the basal-lateral segment solely in the patients with QRS duration ≤ 120 ms (Φ = 0.707; p value ≤ 0.001). Conclusion: The akinetic segment on 2-dimensional echocardiogram was not matched with the latest activation sites in the LV determined by TDI in patients with ICM. PMID:27956911

Cardiac-resynchronization therapy for mild-to-moderate heart failure.

PubMed

Tang, Anthony S L; Wells, George A; Talajic, Mario; Arnold, Malcolm O; Sheldon, Robert; Connolly, Stuart; Hohnloser, Stefan H; Nichol, Graham; Birnie, David H; Sapp, John L; Yee, Raymond; Healey, Jeffrey S; Rouleau, Jean L

2010-12-16

Cardiac-resynchronization therapy (CRT) benefits patients with left ventricular systolic dysfunction and a wide QRS complex. Most of these patients are candidates for an implantable cardioverter-defibrillator (ICD). We evaluated whether adding CRT to an ICD and optimal medical therapy might reduce mortality and morbidity among such patients. We randomly assigned patients with New York Heart Association (NYHA) class II or III heart failure, a left ventricular ejection fraction of 30% or less, and an intrinsic QRS duration of 120 msec or more or a paced QRS duration of 200 msec or more to receive either an ICD alone or an ICD plus CRT. The primary outcome was death from any cause or hospitalization for heart failure. We followed 1798 patients for a mean of 40 months. The primary outcome occurred in 297 of 894 patients (33.2%) in the ICD-CRT group and 364 of 904 patients (40.3%) in the ICD group (hazard ratio in the ICD-CRT group, 0.75; 95% confidence interval [CI], 0.64 to 0.87; P<0.001). In the ICD-CRT group, 186 patients died, as compared with 236 in the ICD group (hazard ratio, 0.75; 95% CI, 0.62 to 0.91; P = 0.003), and 174 patients were hospitalized for heart failure, as compared with 236 in the ICD group (hazard ratio, 0.68; 95% CI, 0.56 to 0.83; P<0.001). However, at 30 days after device implantation, adverse events had occurred in 124 patients in the ICD-CRT group, as compared with 58 in the ICD group (P<0.001). Among patients with NYHA class II or III heart failure, a wide QRS complex, and left ventricular systolic dysfunction, the addition of CRT to an ICD reduced rates of death and hospitalization for heart failure. This improvement was accompanied by more adverse events. (Funded by the Canadian Institutes of Health Research and Medtronic of Canada; ClinicalTrials.gov number, NCT00251251.).

Triple-site pacing for cardiac resynchronization in permanent atrial fibrillation - Acute phase results from a prospective observational study.

PubMed

Marques, Pedro; Nobre Menezes, Miguel; Lima da Silva, Gustavo; Bernardes, Ana; Magalhães, Andreia; Cortez-Dias, Nuno; Carpinteiro, Luís; de Sousa, João; Pinto, Fausto J

2016-06-01

Multi-site pacing is emerging as a new method for improving response to cardiac resynchronization therapy (CRT), but has been little studied, especially in patients with atrial fibrillation. We aimed to assess the effects of triple-site (Tri-V) vs. biventricular (Bi-V) pacing on hemodynamics and QRS duration. This was a prospective observational study of patients with permanent atrial fibrillation and ejection fraction <40% undergoing CRT implantation (n=40). One right ventricular (RV) lead was implanted in the apex and another in the right ventricular outflow tract (RVOT) septal wall. A left ventricular (LV) lead was implanted in a conventional venous epicardial position. Cardiac output (using the FloTrac™ Vigileo™ system), mean QRS and ejection fraction were calculated. Mean cardiac output was 4.81±0.97 l/min with Tri-V, 4.68±0.94 l/min with RVOT septal and LV pacing, and 4.68±0.94 l/min with RV apical and LV pacing (p<0.001 for Tri-V vs. both BiV). Mean pre-implantation QRS was 170±25 ms, 123±18 ms with Tri-V, 141±25 ms with RVOT septal pacing and LV pacing and 145±19 with RV apical and LV pacing (p<0.001 for Tri-V vs. both BiV and pre-implantation). Mean ejection fraction was significantly higher with Tri-V (30±11%) vs. Bi-V pacing (28±12% with RVOT septal and LV pacing and 28±11 with RV apical and LV pacing) and pre-implantation (25±8%). Tri-V pacing produced higher cardiac output and shorter QRS duration than Bi-V pacing. This may have a significant impact on the future of CRT. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

Counterclockwise and Clockwise Rotation of QRS Transitional Zone: Prospective Correlates of Change and Time-Varying Associations With Cardiovascular Outcomes.

PubMed

Patel, Siddharth; Kwak, Lucia; Agarwal, Sunil K; Tereshchenko, Larisa G; Coresh, Josef; Soliman, Elsayed Z; Matsushita, Kunihiro

2017-11-03

A few studies have recently reported clockwise and counterclockwise rotations of QRS transition zone as predictors of mortality. However, their prospective correlates and associations with individual cardiovascular disease (CVD) outcomes are yet to be investigated. Among 13 567 ARIC (Atherosclerosis Risk in Communities) study participants aged 45 to 64 years, we studied key correlates of changes in the status of clockwise and counterclockwise rotation over time as well as the association of rotation status with incidence of coronary heart disease (2408 events), heart failure (2196 events), stroke (991 events), composite CVD (4124 events), 898 CVD deaths, and 3469 non-CVD deaths over 23 years of follow-up. At baseline, counterclockwise rotation was most prevalent (52.9%), followed by no (40.5%) and clockwise (6.6%) rotation. Of patients with no rotation, 57.9% experienced counterclockwise or clockwise rotation during follow-up, with diabetes mellitus and black race significantly predicting clockwise and counterclockwise conversion, respectively. Clockwise rotation was significantly associated with higher risk of heart failure (hazard ratio, 1.20; 95% confidence interval [CI], 1.02-1.41) and non-CVD death (hazard ratio, 1.28; 95% CI, 1.12-1.46) after adjusting for potential confounders including other ECG parameters. On the contrary, counterclockwise rotation was significantly related to lower risk of composite CVD (hazard ratio, 0.93; 95% CI, 0.87-0.99]), CVD mortality (hazard ratio, 0.76; 95% CI, 0.65-0.88), and non-CVD deaths (hazard ratio, 0.92; 95% CI, 0.85-0.99 [borderline significance with heart failure]). Counterclockwise rotation, the most prevalent QRS transition zone pattern, demonstrated the lowest risk of CVD and mortality, whereas clockwise rotation was associated with the highest risk of heart failure and non-CVD mortality. These results have implications on how to interpret QRS transition zone rotation when ECG was recorded. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Programming Cardiac Resynchronization Therapy for Electrical Synchrony: Reaching Beyond Left Bundle Branch Block and Left Ventricular Activation Delay.

PubMed

Varma, Niraj; O'Donnell, David; Bassiouny, Mohammed; Ritter, Philippe; Pappone, Carlo; Mangual, Jan; Cantillon, Daniel; Badie, Nima; Thibault, Bernard; Wisnoskey, Brian

2018-02-06

QRS narrowing following cardiac resynchronization therapy with biventricular (BiV) or left ventricular (LV) pacing is likely affected by patient-specific conduction characteristics (PR, qLV, LV-paced propagation interval), making a universal programming strategy likely ineffective. We tested these factors using a novel, device-based algorithm (SyncAV) that automatically adjusts paced atrioventricular delay (default or programmable offset) according to intrinsic atrioventricular conduction. Seventy-five patients undergoing cardiac resynchronization therapy (age 66±11 years; 65% male; 32% with ischemic cardiomyopathy; LV ejection fraction 28±8%; QRS duration 162±16 ms) with intact atrioventricular conduction (PR interval 194±34, range 128-300 ms), left bundle branch block, and optimized LV lead position were studied at implant. QRS duration (QRSd) reduction was compared for the following pacing configurations: nominal simultaneous BiV (Mode I: paced/sensed atrioventricular delay=140/110 ms), BiV+SyncAV with 50 ms offset (Mode II), BiV+SyncAV with offset that minimized QRSd (Mode III), or LV-only pacing+SyncAV with 50 ms offset (Mode IV). The intrinsic QRSd (162±16 ms) was reduced to 142±17 ms (-11.8%) by Mode I, 136±14 ms (-15.6%) by Mode IV, and 132±13 ms (-17.8%) by Mode II. Mode III yielded the shortest overall QRSd (123±12 ms, -23.9% [ P <0.001 versus all modes]) and was the only configuration without QRSd prolongation in any patient. QRS narrowing occurred regardless of QRSd, PR, or LV-paced intervals, or underlying ischemic disease. Post-implant electrical optimization in already well-selected patients with left bundle branch block and optimized LV lead position is facilitated by patient-tailored BiV pacing adjusted to intrinsic atrioventricular timing using an automatic device-based algorithm. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Accuracy of computer-calculated and manual QRS duration assessments: Clinical implications to select candidates for cardiac resynchronization therapy.

PubMed

De Pooter, Jan; El Haddad, Milad; Stroobandt, Roland; De Buyzere, Marc; Timmermans, Frank

2017-06-01

QRS duration (QRSD) plays a key role in the field of cardiac resynchronization therapy (CRT). Computer-calculated QRSD assessments are widely used, however inter-manufacturer differences have not been investigated in CRT candidates. QRSD was assessed in 377 digitally stored ECGs: 139 narrow QRS, 140 LBBB and 98 ventricular paced ECGs. Manual QRSD was measured as global QRSD, using digital calipers, by two independent observers. Computer-calculated QRSD was assessed by Marquette 12SL (GE Healthcare, Waukesha, WI, USA) and SEMA3 (Schiller, Baar, Switzerland). Inter-manufacturer differences of computer-calculated QRSD assessments vary among different QRS morphologies: narrow QRSD: 4 [2-9] ms (median [IQR]), p=0.010; LBBB QRSD: 7 [2-10] ms, p=0.003 and paced QRSD: 13 [6-18] ms, p=0.007. Interobserver differences of manual QRSD assessments measured: narrow QRSD: 4 [2-6] ms, p=non-significant; LBBB QRSD: 6 [3-12] ms, p=0.006; paced QRSD: 8 [4-18] ms, p=0.001. In LBBB ECGs, intraclass correlation coefficients (ICCs) were comparable for inter-manufacturer and interobserver agreement (ICC 0.830 versus 0.837). When assessing paced QRSD, manual measurements showed higher ICC compared to inter-manufacturer agreement (ICC 0.902 versus 0.776). Using guideline cutoffs of 130ms, up to 15% of the LBBB ECGs would be misclassified as <130ms or ≥130ms by at least one method. Using a cutoff of 150ms, this number increases to 33% of ECGs being misclassified. However, by combining LBBB-morphology and QRSD, the number of misclassified ECGs can be decreased by half. Inter-manufacturer differences in computer-calculated QRSD assessments are significant and may compromise adequate selection of individual CRT candidates when using QRSD as sole parameter. Paced QRSD should preferentially be assessed by manual QRSD measurements. Copyright © 2017 Elsevier B.V. All rights reserved.

ECG parameters predict left ventricular conduction delay in patients with left ventricular dysfunction.

PubMed

Pastore, Gianni; Maines, Massimiliano; Marcantoni, Lina; Zanon, Francesco; Noventa, Franco; Corbucci, Giorgio; Baracca, Enrico; Aggio, Silvio; Picariello, Claudio; Lanza, Daniela; Rigatelli, Gianluca; Carraro, Mauro; Roncon, Loris; Barold, S Serge

2016-12-01

Estimating left ventricular electrical delay (Q-LV) from a 12-lead ECG may be important in evaluating cardiac resynchronization therapy (CRT). The purpose of this study was to assess the impact of Q-LV interval on ECG configuration. One hundred ninety-two consecutive patients undergoing CRT implantation were divided electrocardiographically into 3 groups: left bundle branch block (LBBB), right bundle branch block (RBBB), and nonspecific intraventricular conduction delay (IVCD). The IVCD group was further subdivided into 81 patients with left (L)-IVCD and 15 patients with right (R)-IVCD (resembling RBBB, but without S wave in leads I and aVL). The Q-LV interval in the different groups and the relationship between ECG parameters and the maximum Q-LV interval were analyzed. Patients with LBBB presented a long Q-LV interval (147.7 ± 14.6 ms, all exceeding cutoff value of 110 ms), whereas RBBB patients presented a very short Q-LV interval (75.2 ± 16.3 ms, all <110 ms). Patients with an IVCD displayed a wide range of Q-LV intervals. In L-IVCD, mid-QRS notching/slurring showed the strongest correlation with a longer Q-LV interval, followed, in decreasing order, by QRS duration >150 ms and intrinsicoid deflection >60 ms. Isolated mid-QRS notching/slurring predicted Q-LV interval >110 ms in 68% of patients. The R-IVCD group presented an unexpectedly longer Q-LV interval (127.0 ± 12.5 ms; 13/15 patients had Q-LV >110 ms). Patients with LBBB have a very prolonged Q-LV interval. Mid-QRS notching in lateral leads strongly predicts a longer Q-LV interval in L-IVCD patients. Patients with R-IVCD constitute a subgroup of patients with a long Q-LV interval. Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Electrocardiogram Abnormalities and Coronary Calcification in Postmenopausal Women

PubMed Central

Sabour, Siamak; Grobbee, Diederick; Rutten, Annemarieke; Prokop, Mathias; Bartelink, Marie-Louise; van der Schouw, Yvonne; Bots, Michiel

2010-01-01

Background: An electrocardiogram (ECG) can provide information on subclinical myocardial damage. The presence, and more importantly, the quantity of coronary artery calcification (CAC), relates well with the overall severity of the atherosclerotic process. A strong relation has been demonstrated between coronary calcium burden and the incidence of myocardial infarction, a relation independent of age. The aim of this study was to assess the relation of left ventricular hypertrophy (LVH) and ECG abnormalities with CAC. Methods: The study population comprised 566 postmenopausal women selected from a population-based cohort study. Information on LVH and repolarization abnormalities (T-axis and QRS-T angle) was obtained using electrocardiography. Modular ECG Analysis System (MEANS) was used to assess ECG abnormalities. The women underwent a multi detector-row computed tomography (MDCT) scan (Philips Mx 8000 IDT 16) to assess CAC. The Agatston score was used to quantify CAC; scores greater than zero were considered as the presence of coronary calcium. Logistic regression was used to assess the relation of ECG abnormality with coronary calcification. Results: LVH was found in 2.7% (n = 15) of the women. The prevalence of T-axis abnormality was 6% (n = 34), whereas 8.5% (n = 48) had a QRS-T angle abnormality. CAC was found in 62% of the women. Compared to women with a normal T-axis, women with borderline or abnormal T-axes were 3.8 fold more likely to have CAC (95% CI: 1.4–10.2). Similarly, compared to women with a normal QRS-T angle, in women with borderline or abnormal QRS-T angle, CAC was 2.0 fold more likely to be present (95% CI: 1.0–4.1). Conclusion: Among women with ECG abnormalities reflecting subclinical ischemia, CAC is commonly found and may in part explain the increased coronary heart disease risk associated with these ECG abnormalities. PMID:23074563

Exciton Fine-Structure Splitting in Self-Assembled Lateral InAs/GaAs Quantum-Dot Molecular Structures.

PubMed

Fillipov, Stanislav; Puttisong, Yuttapoom; Huang, Yuqing; Buyanova, Irina A; Suraprapapich, Suwaree; Tu, Charles W; Chen, Weimin M

2015-06-23

Fine-structure splitting (FSS) of excitons in semiconductor nanostructures is a key parameter that has significant implications in photon entanglement and polarization conversion between electron spins and photons, relevant to quantum information technology and spintronics. Here, we investigate exciton FSS in self-organized lateral InAs/GaAs quantum-dot molecular structures (QMSs) including laterally aligned double quantum dots (DQDs), quantum-dot clusters (QCs), and quantum rings (QRs), by employing polarization-resolved microphotoluminescence (μPL) spectroscopy. We find a clear trend in FSS between the studied QMSs depending on their geometric arrangements, from a large FSS in the DQDs to a smaller FSS in the QCs and QRs. This trend is accompanied by a corresponding difference in the optical polarization directions of the excitons between these QMSs, namely, the bright-exciton lines are linearly polarized preferably along or perpendicular to the [11̅0] crystallographic axis in the DQDs that also defines the alignment direction of the two constituting QDs, whereas in the QCs and QRs, the polarization directions are randomly oriented. We attribute the observed trend in the FSS to a significant reduction of the asymmetry in the lateral confinement potential of the excitons in the QRs and QCs as compared with the DQDs, as a result of a compensation between the effects of lateral shape anisotropy and piezoelectric field. Our work demonstrates that FSS strongly depends on the geometric arrangements of the QMSs, which effectively tune the degree of the compensation effects and are capable of reducing FSS even in a strained QD system to a limit similar to strain-free QDs. This approach provides a pathway in obtaining high-symmetry quantum emitters desirable for realizing photon entanglement and spintronic devices based on such nanostructures, utilizing an uninterrupted epitaxial growth procedure without special requirements for lattice-matched materials combinations, specific substrate orientations, and nanolithography.

The prognostic impact of dynamic ventricular dyssynchrony in patients with idiopathic dilated cardiomyopathy and narrow QRS.

PubMed

D'Andrea, Antonello; Mele, Donato; Nistri, Stefano; Riegler, Lucia; Galderisi, Maurizio; Agricola, Eustachio; Losi, Maria Angela; Ballo, Piercarlo; Mondillo, Sergio; Badano, Luigi P

2013-02-01

Asynchronous myocardial contraction adversely influences left ventricular (LV) function and is therefore associated with a poor prognosis in heart failure. Exercise-induced change in ventricular dyssynchrony may be an important determinant of dynamic changes in cardiac output and mitral regurgitation. A prospective, longitudinal study was designed with pre-defined dyssynchrony index and outcome variables to test the hypothesis that dynamic dyssynchrony is associated with worse long-term event-free survival in patients with dilated cardiomyopathy (DCM) and 'narrow' QRS complex. One-hundred eighty patients (62 ± 8 years; 110 males) with NYHA class II-III, idiopathic DCM, ejection fraction ≤35%, and QRS duration <120 ms were selected. All the patients underwent standard Doppler echo, colour tissue velocity imaging (DTI), and supine bicycle exercise stress echocardiography. Cardiac synchronicity was defined, at rest and at peak exercise, as DTI velocity opposing-wall delay (significant if ≥65 ms). Outcome was defined as freedom from death, heart transplantation, or LV-assist device implantation, over a median follow-up of 48 months, and a Cox proportional hazards model was used for survival analysis. At baseline examination, DCM patients showed a reduced LV ejection fraction (31 + 4%). A significant electromechanical delay in 58 patients (32%). At the peak of physical exercise, a significant electromechanical delay was detected in 103 patients (57%). There were 41 events during the follow-up (23%): 28 cardiac deaths, 8 heart transplantations, and 5 LV-assist device implantations over 4 years. When adjusted for confounding baseline variables, LV end-diastolic volume, restrictive mitral flow pattern, severity of mitral regurgitation, and the presence of exercise-induced intraventricular dyssynchrony were the only independent determinants of an adverse outcome. In patients with idiopathic DCM and narrow QRS, the increase in echocardiographic dyssynchrony during exercise was the strongest predictor of less favourable event-free survival.

Expression, purification, crystallization and preliminary X-ray analysis of a C-terminal fragment of the Epstein–Barr virus ZEBRA protein

DOE Office of Scientific and Technical Information (OSTI.GOV)

Morand, Patrice; Laboratoire de Virologie Moléculaire et Structurale, EA 2939, Université Joseph Fourier, Grenoble; Budayova-Spano, Monika

A C-terminal fragment of the Epstein–Barr virus lytic switch protein ZEBRA has been crystallized in complex with DNA. A C-terminal fragment of the Epstein–Barr virus immediate-early transcription factor ZEBRA has been expressed as a recombinant protein in Escherichia coli and purified to homogeneity. The fragment behaves as a dimer in solution, consistent with the presence of a basic region leucine-zipper (bZIP) domain. Crystals of the fragment in complex with a DNA duplex were grown by the hanging-drop vapour-diffusion technique using polyethylene glycol 4000 and magnesium acetate as crystallization agents. Crystals diffract to better than 2.5 Å resolution using synchrotron radiationmore » (λ = 0.976 Å). Crystals belong to space group C2, with unit-cell parameters a = 94.2, b = 26.5, c = 98.1 Å, β = 103.9°.« less

Study of the Cross-Reactions of Hen and Duck Ovalbumins. Immunochemical Relationship between Native Proteins and Precipitating Fragments obtained after Proteolysis

PubMed Central

Kaminski, Marie

1962-01-01

The enzymatic digestion of duck ovalbumin yields precipitating fragments similar to those obtained with hen ovalbumin. In an anti-ovalbumin serum, the amount of antibody precipitating with the two fragments of degraded homologous ovalbumin and the amount of antibody precipitating with the heterologous ovalbumin are independent. The absorption of an anti-ovalbumin serum with the heterologous ovalbumin does not remove selectively the antibodies against one or another fragment of the degraded homologous antigen. The corresponding fragments obtained by digestion of hen and duck ovalbumins give cross-reactions when tested with anti-hen-ovalbumin serum, anti-duck-ovalbumin serum and anti-degraded-hen-ovalbumin serum. On double diffusion in agar, the cross-reaction between the native ovalbumin and its fragment yields a spur which is shorter than the spur formed by the two native ovalbumins or by the two corresponding fragments. ImagesFIG. 1FIG. 2FIG. 3FIG. 4FIG. 5FIG. 6FIG. 7FIG. 8FIG. 9FIG. 11FIG. 12FIG. 13 PMID:14453463

X-ray studies of recombinant anti-testosterone Fab fragments: the use of PEG 3350 in crystallization.

PubMed

Valjakka, J; Hemminki, A; Teerinen, T; Takkinen, K; Rouvinen, J

2000-02-01

Recombinant anti-testosterone wild-type Fab fragment and mutant Fab fragments with high binding selectivity developed by protein engineering have been crystallized with and without ligands. Crystals of these Fab fragments were obtained by the vapour-diffusion technique at room temperature using solutions of PEG 3350 with various biological buffers and with a wide pH range. So far, five data sets have been collected from crystals of three Fab-antigen complexes and from two uncomplexed Fab fragments, with resolutions ranging from 2.10 to 3.1 A. Crystallization conditions for Fab fragments were found by using modifications of the low ionic strength PEG 3350 series. Suitable concentrations of PEG 400, MPD and glycerol solutions for use as cryoprotectants in PEG 3350 solutions have been determined. One useful observation was that PEG 3350 is able to work alone as a cryoprotectant. The screening protocol used requires a smaller amount of protein material to achieve auspicious pre-crystals than previously. Results support the claim that PEG 3350 is more suitable for the crystallization of Fab fragments than higher molecular weight PEGs.

A consensus algorithm for approximate string matching and its application to QRS complex detection

NASA Astrophysics Data System (ADS)

Alba, Alfonso; Mendez, Martin O.; Rubio-Rincon, Miguel E.; Arce-Santana, Edgar R.

2016-08-01

In this paper, a novel algorithm for approximate string matching (ASM) is proposed. The novelty resides in the fact that, unlike most other methods, the proposed algorithm is not based on the Hamming or Levenshtein distances, but instead computes a score for each symbol in the search text based on a consensus measure. Those symbols with sufficiently high scores will likely correspond to approximate instances of the pattern string. To demonstrate the usefulness of the proposed method, it has been applied to the detection of QRS complexes in electrocardiographic signals with competitive results when compared against the classic Pan-Tompkins (PT) algorithm. The proposed method outperformed PT in 72% of the test cases, with no extra computational cost.

Cardiac resynchronization therapy with His bundle pacing as a method of treatment of chronic heart failure in patients with permanent atrial fibrillation and left bundle branch block.

PubMed

Boczar, Krzysztof; Sławuta, Agnieszka; Ząbek, Andrzej; Dębski, Maciej; Gajek, Jacek; Lelakowski, Jacek; Małecka, Barbara

CRT is a therapeutic option for patients with heart failure, sinus rhythm, prolonged QRS complex duration and reduced ejection fraction. We present a case of 71-year-old woman with dilated cardiomyopathy, NYHA functional class III and AF. We implanted CRT combined with direct His-bundle pacing. The indication for such a therapy was a left bundle branch block with a QRS complex of 178ms and a left ventricular EF of 15%, left ventricular end-diastolic diameter (LVEDD) of 75mm. After 8months of follow-up the LVEDD was 60mm with EF 35-40%. Copyright © 2017. Published by Elsevier Inc.

Time frequency power profile of QRS complex obtained with wavelet transform in spontaneously hypertensive rats.

PubMed

Takano, Nami K; Tsutsumi, Takeshi; Suzuki, Hiroshi; Okamoto, Yoshiwo; Nakajima, Toshiaki

2012-02-01

We evaluated whether frequency analysis could detect the development of interstitial fibrosis in rats. SHR/Izm and age-matched WKY/Izm were used. Limb lead II electrocardiograms were recorded. Continuous wavelet transform (CWT) was applied for the time-frequency analysis. The integrated time-frequency power (ITFP) between QRS complexes was measured and compared between groups. The ITFP at low-frequency bands (≤125Hz) was significantly higher in SHR/Izm. The percent change of ITFP showed the different patterns between groups. Prominent interstitial fibrosis with an increase in TIMP-1 mRNA expression was also observed in SHR/Izm. These results were partly reproduced in a computer simulation. Copyright © 2011 Elsevier Ltd. All rights reserved.

Electrocardiogram reference intervals for clinically normal wild-born chimpanzees (Pan troglodytes).

PubMed

Atencia, Rebeca; Revuelta, Luis; Somauroo, John D; Shave, Robert E

2015-08-01

To generate reference intervals for ECG variables in clinically normal chimpanzees (Pan troglodytes). 100 clinically normal (51 young [< 10 years old] and 49 adult [≥ 10 years old]) wild-born chimpanzees. Electrocardiograms collected between 2009 and 2013 at the Tchimpounga Chimpanzee Rehabilitation Centre were assessed to determine heart rate, PR interval, QRS duration, QT interval, QRS axis, P axis, and T axis. Electrocardiographic characteristics for left ventricular hypertrophy (LVH) and morphology of the ST segment, T wave, and QRS complex were identified. Reference intervals for young and old animals were calculated as mean ± 1.96•SD for normally distributed data and as 5th to 95th percentiles for data not normally distributed. Differences between age groups were assessed by use of unpaired Student t tests. RESULTS Reference intervals were generated for young and adult wild-born chimpanzees. Most animals had sinus rhythm with small or normal P wave morphology; 24 of 51 (47%) young chimpanzees and 30 of 49 (61%) adult chimpanzees had evidence of LVH as determined on the basis of criteria for humans. Cardiac disease has been implicated as the major cause of death in captive chimpanzees. Species-specific ECG reference intervals for chimpanzees may aid in the diagnosis and treatment of animals with, or at risk of developing, heart disease. Chimpanzees with ECG characteristics outside of these intervals should be considered for follow-up assessment and regular cardiac monitoring.

Adaptive EMG noise reduction in ECG signals using noise level approximation

NASA Astrophysics Data System (ADS)

Marouf, Mohamed; Saranovac, Lazar

2017-12-01

In this paper the usage of noise level approximation for adaptive Electromyogram (EMG) noise reduction in the Electrocardiogram (ECG) signals is introduced. To achieve the adequate adaptiveness, a translation-invariant noise level approximation is employed. The approximation is done in the form of a guiding signal extracted as an estimation of the signal quality vs. EMG noise. The noise reduction framework is based on a bank of low pass filters. So, the adaptive noise reduction is achieved by selecting the appropriate filter with respect to the guiding signal aiming to obtain the best trade-off between the signal distortion caused by filtering and the signal readability. For the evaluation purposes; both real EMG and artificial noises are used. The tested ECG signals are from the MIT-BIH Arrhythmia Database Directory, while both real and artificial records of EMG noise are added and used in the evaluation process. Firstly, comparison with state of the art methods is conducted to verify the performance of the proposed approach in terms of noise cancellation while preserving the QRS complex waves. Additionally, the signal to noise ratio improvement after the adaptive noise reduction is computed and presented for the proposed method. Finally, the impact of adaptive noise reduction method on QRS complexes detection was studied. The tested signals are delineated using a state of the art method, and the QRS detection improvement for different SNR is presented.

Role of echocardiography before cardiac resynchronization therapy: new advances and current developments.

PubMed

Marechaux, Sylvestre; Menet, Aymeric; Guyomar, Yves; Ennezat, Pierre-Vladimir; Guerbaai, Raphaëlle Ashley; Graux, Pierre; Tribouilloy, Christophe

2016-11-01

The role of echocardiography in improving the selection of patients who will benefit from cardiac resynchronization therapy (CRT) remains a source of debate. Although previous landmark reports have demonstrated a link between mechanical dyssynchrony, assessed by delays between left ventricle (LV) walls and response to CRT, the predictive value of these findings has not yet been confirmed in multicenter trials. Indeed, recent studies demonstrated that the classical assessment of LV mechanical dyssynchrony using delay between walls by echocardiography depends not only on LV electrical activation delay (electrical dyssynchrony), but also on abnormalities in regional contractility of the LV and/or loading conditions, which do not represent an appropriate target for CRT. Recent reports highlighted the value of new indices of electromechanical dyssynchrony obtained by echocardiography, to predict LV response and outcome after CRT including septal flash, left bundle branch block-typical pattern by longitudinal strain, apical rocking, septal strain patterns, and systolic stretch index. This was achieved using a mechanistic approach, based on the contractile consequences of electrical dyssynchrony. These indices are rarely found in patients with narrow QRS (<120 ms), whereas their frequency rises in patients with an increase in QRS duration (>120 ms). Theses indices should improve candidate selection for CRT in clinical practice, especially for patients in whom the benefit of CRT remains uncertain, for example, patients with intermediate QRS width (120-150 ms). © 2016, Wiley Periodicals, Inc.

Detection of ischemical dyssynchrony in patients with normal duration of QRS at rest and during exercise echocardiography (Dyssynchrony in coronary artery disease patients during exercise).

PubMed

Zagatina, A; Guseva, O; Bartosh-Zelenaya, S Y; Zhuravskaya, N

2014-04-01

Ischemic segments cannot develop a sufficient amount of strength during systole, so theoretically they begin to contract later in comparison with non-ischemic zones. There is a lack of information about methods that can detect dyssynchrony during exercise in patients with QRS not longer 100 ms. The aim of the study was to compare different methods of detection regarding left ventricular moving dyssynchrony in patients with significant coronary stenosis artery lesions: pulsed-wave of PW-TDI, strain (S) and strain rate (SR). The study included 133 subjects: 106 consecutive patients who were scheduled for coronary angiography with previous stress-echocardiography and 27 healthy persons. All the patients underwent a supine bicycle exercise test. Seventy-six patients had stenoses and 30 subjects had no significant lesions by coronary angiography. There was a detectable difference between time parameters of left ventricle contraction for the two groups and controls before and during exercise using all Doppler methods. Subgroups of patients without previous myocardial infarction and without hypertrophy of left ventricle had the same results. Maximal difference was observed using strain method. There was a moderate correlation between time parameters and the existence of significant lesions of coronary arteries. Patients without prolongations of QRS with significant lesions of coronary arteries have detectable left ventricular dyssynchrony before and during exercise.

[Analysis of pacemaker ECGs].

PubMed

Israel, Carsten W; Ekosso-Ejangue, Lucy; Sheta, Mohamed-Karim

2015-09-01

The key to a successful analysis of a pacemaker electrocardiogram (ECG) is the application of the systematic approach used for any other ECG without a pacemaker: analysis of (1) basic rhythm and rate, (2) QRS axis, (3) PQ, QRS and QT intervals, (4) morphology of P waves, QRS, ST segments and T(U) waves and (5) the presence of arrhythmias. If only the most obvious abnormality of a pacemaker ECG is considered, wrong conclusions can easily be drawn. If a systematic approach is skipped it may be overlooked that e.g. atrial pacing is ineffective, the left ventricle is paced instead of the right ventricle, pacing competes with intrinsic conduction or that the atrioventricular (AV) conduction time is programmed too long. Apart from this analysis, a pacemaker ECG which is not clear should be checked for the presence of arrhythmias (e.g. atrial fibrillation, atrial flutter, junctional escape rhythm and endless loop tachycardia), pacemaker malfunction (e.g. atrial or ventricular undersensing or oversensing, atrial or ventricular loss of capture) and activity of specific pacing algorithms, such as automatic mode switching, rate adaptation, AV delay modifying algorithms, reaction to premature ventricular contractions (PVC), safety window pacing, hysteresis and noise mode. A systematic analysis of the pacemaker ECG almost always allows a probable diagnosis of arrhythmias and malfunctions to be made, which can be confirmed by pacemaker control and can often be corrected at the touch of the right button to the patient's benefit.

Screening of young competitive athletes for the prevention of sudden cardiac death with a wireless electrocardiographic transmission device: a pilot study.

PubMed

Cho, Jae Hyung; Selen, Mats A; Kocheril, Abraham G

2015-08-11

The 12-lead electrocardiographic screening for the prevention of sudden cardiac death in young competitive athletes is not cost-effective and thus not routinely recommended. We investigate whether a less expensive wireless electrocardiographic transmission device can be used to screen for the prevention of sudden cardiac death in this population. During pre-participation screening, twenty college football players underwent two electrocardiograms: a conventional 12-lead electrocardiogram and a wireless 9-lead electrocardiogram. We compared several electrocardiographic parameters (QRS duration, left ventricular hypertrophy using the Cornell voltage criteria and the Sokolow-Lyon criteria, ST deviation and corrected QT interval) to determine the correlation. The QRS duration, left ventricular hypertrophy using the Cornell voltage criteria and the Sokolow-Lyon criteria and corrected QT interval exhibited significant correlation between the two types of electrocardiograms (correlation coefficient 0.878, 0.630, 0.770 and 0.847, respectively with P values of 0.01, 0.003, 0.01 and 0.01, respectively). ST deviation in V1 was weakly correlated between the two types of electrocardiograms without statistical significance (correlation coefficient 0.360 with a P value of 0.119). Our newly developed wireless 9-lead electrocardiogram demonstrated significant correlations with a conventional 12-lead electrocardiogram in terms of QRS duration, left ventricular hypertrophy and corrected QT interval.

Diffusion processes of fragmentary information on scale-free networks

NASA Astrophysics Data System (ADS)

Li, Xun; Cao, Lang

2016-05-01

Compartmental models of diffusion over contact networks have proven representative of real-life propagation phenomena among interacting individuals. However, there is a broad class of collective spreading mechanisms departing from compartmental representations, including those for diffusive objects capable of fragmentation and transmission unnecessarily as a whole. Here, we consider a continuous-state susceptible-infected-susceptible (SIS) model as an ideal limit-case of diffusion processes of fragmentary information on networks, where individuals possess fractions of the information content and update them by selectively exchanging messages with partners in the vicinity. Specifically, we incorporate local information, such as neighbors' node degrees and carried contents, into the individual partner choice, and examine the roles of a variety of such strategies in the information diffusion process, both qualitatively and quantitatively. Our method provides an effective and flexible route of modulating continuous-state diffusion dynamics on networks and has potential in a wide array of practical applications.

Ventricular Tachycardia or not? An Unexpected Reason of Wide QRS Complex Tachycardia in a Young Healthy Man: Sodium Bicarbonate.

PubMed

Eyuboglu, Mehmet

2016-10-01

Ventricular tachycardia (VT) is life-threatening subgroup of wide QRS complex tachycardia (WCT). VT is usually associated with structural heart diseases, but it can occur in the absence of any cardiovascular diseases. Adverse cardiac effect of sodium bicarbonate in healthy subjects is not well described. A 30-year-old healthy man with excessive intake of sodium bicarbonate-related VT is presented. He was using sodium bicarbonate during last 2 months to lose weight. He has no risk factors and any cardiovascular or systemic diseases. After intravenous administration of amiodarone, tachycardia ended and his rhythm converted to sinus rhythm with normal electrocardiogram. Patient is asymptomatic, and no VT was observed without any medications at 1 year of follow-up.

Design of a cardiac monitor in terms of parameters of QRS complex.

PubMed

Chen, Zhen-cheng; Ni, Li-li; Su, Ke-ping; Wang, Hong-yan; Jiang, Da-zong

2002-08-01

Objective. To design a portable cardiac monitor system based on the available ordinary ECG machine and works on the basis of QRS parameters. Method. The 80196 single chip microcomputer was used as the central microprocessor and real time electrocardiac signal was collected and analyzed [correction of analysized] in the system. Result. Apart from the performance of an ordinary monitor, this machine possesses also the following functions: arrhythmia analysis, HRV analysis, alarm, freeze, and record of automatic papering. Convenient in carrying, the system is powered by AC or DC sources. Stability, low power and low cost are emphasized in the hardware design; and modularization method is applied in software design. Conclusion. Popular in usage and low cost made the portable monitor system suitable for use under simple conditions.

Real-time ECG monitoring and arrhythmia detection using Android-based mobile devices.

PubMed

Gradl, Stefan; Kugler, Patrick; Lohmuller, Clemens; Eskofier, Bjoern

2012-01-01

We developed an application for Android™-based mobile devices that allows real-time electrocardiogram (ECG) monitoring and automated arrhythmia detection by analyzing ECG parameters. ECG data provided by pre-recorded files or acquired live by accessing a Shimmer™ sensor node via Bluetooth™ can be processed and evaluated. The application is based on the Pan-Tompkins algorithm for QRS-detection and contains further algorithm blocks to detect abnormal heartbeats. The algorithm was validated using the MIT-BIH Arrhythmia and MIT-BIH Supraventricular Arrhythmia databases. More than 99% of all QRS complexes were detected correctly by the algorithm. Overall sensitivity for abnormal beat detection was 89.5% with a specificity of 80.6%. The application is available for download and may be used for real-time ECG-monitoring on mobile devices.

The energy-efficient implementation of an adaptive-filtering-based QRS complex detection method for wearable devices

NASA Astrophysics Data System (ADS)

Tian, Shudong; Han, Jun; Yang, Jianwei; Zeng, Xiaoyang

2017-10-01

Electrocardiogram (ECG) can be used as a valid way for diagnosing heart disease. To fulfill ECG processing in wearable devices by reducing computation complexity and hardware cost, two kinds of adaptive filters are designed to perform QRS complex detection and motion artifacts removal, respectively. The proposed design achieves a sensitivity of 99.49% and a positive predictivity of 99.72%, tested under the MIT-BIH ECG database. The proposed design is synthesized under the SMIC 65-nm CMOS technology and verified by post-synthesis simulation. Experimental results show that the power consumption and area cost of this design are of 160 μW and 1.09 × 10 5 μm2, respectively. Project supported by the National Natural Science Foundation of China (Nos. 61574040, 61234002, 61525401).

Electroconvulsive therapy-induced Wolff-Parkinson-White syndrome: a case report.

PubMed

Enomoto, Shingo; Yoshino, Aihide; Takase, Bonpei; Kuwahara, Tatsuro; Tatsuzawa, Yasutaka; Nomura, Soichiro

2013-01-01

Wolff-Parkinson-White (WPW) syndrome is characterized by premature ventricular excitation due to the presence of an abnormal accessory pathway. Electrocardiography (ECG) of patients with WPW syndrome portrays a short PR interval and a wide QRS interval with a delta wave. Herein, we report the case of a patient with schizophrenia who developed a wide QRS interval with a delta wave immediately following electroconvulsive therapy (ECT). Initially, the delta wave disappeared within 2 days after ECT. However, the duration of the delta wave increased exponentially to 4 months when ECT was repeated. Although the patient's cardiocirculatory dynamics remained normal, we continued to monitor her ECG until the delta wave disappeared because WPW syndrome can lead to serious arrhythmia. Copyright © 2013 Elsevier Inc. All rights reserved.

Degree of Agreement between Cardiovascular Risk Stratification Tools.

PubMed

Garcia, Guilherme Thomé; Stamm, Ana Maria Nunes de Faria; Rosa, Ariel Córdova; Marasciulo, Antônio Carlos; Marasciulo, Rodrigo Conill; Battistella, Cristian; Remor, Alexandre Augusto de Costa

2017-05-01

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in Brazil, and primary prevention care may be guided by risk stratification tools. The Framingham (FRS) and QRISK-2 (QRS) risk scores estimate 10-year overall cardiovascular risk in asymptomatic individuals, but the instrument of choice may lead to different therapeutic strategies. To evaluate the degree of agreement between FRS and QRS in 10-year overall cardiovascular risk stratification in disease-free individuals. Cross-sectional, observational, descriptive and analytical study in a convenience sample of 74 individuals attending the outpatient care service of a university hospital in Brazil between January 2014 and January 2015. After application of FRS and QRS, patients were classified in low/moderate risk (< 20%) or high risk (≥ 20%). The proportion of individuals classified as at high risk was higher in FRS than in QRS (33.7% vs 21.6%). A synergic effect of male gender with systemic arterial hypertension was observed in both tools, and with for geriatric age group in QRS (p < 0.05) in high-risk stratum. The Kappa index was 0.519 (95%CI = 0.386-0.652; p < 0.001) between both instruments. There was a moderate agreement between FRS and QRS in estimating 10-year overall cardiovascular risk. The risk scores used in this study can identify synergism between variables, and their behavior is influenced by the population in which it was derived. It is important to recognize the need for calibrating risk scores for the Brazilian population. A doença cardiovascular (DCV) é a principal causa de morbimortalidade no Brasil, e a prevenção primária pode ser direcionada com ferramentas que estratificam o risco. Os escores de Framingham (ERF) e QRISK-2 (ERQ) estimam o risco cardiovascular (RCV) global em 10 anos em indivíduos assintomáticos, mas a escolha do instrumento pode implicar em terapêuticas distintas. Observar o grau de concordância entre o ERF e o ERQ, na estratificação do risco cardiovascular global em 10 anos, nos indivíduos livres da doença. Estudo transversal, observacional, descritivo e analítico, com uma amostra de conveniência de 74 indivíduos, atendidos em um ambulatório de ensino de um hospital universitário brasileiro, no sul do país, de janeiro de 2014 a janeiro de 2015. O ERF e o ERQ foram aplicados nos pacientes, que foram classificados em baixo/moderado (< 20%) ou alto risco (≥ 20%). A proporção de indivíduos classificados no estrato de alto risco foi superior no ERF que no ERQ (33,7% vs 21,6%), sendo identificado efeito sinérgico do gênero masculino com hipertensão arterial sistêmica nas duas ferramentas, e com faixa etária geriátrica no ERQ (p < 0,05) nesse estrato de risco. O índice de concordância Kappa entre os dois escores foi igual a 0,519 (IC95% = 0,386-0,652; p < 0,001). Houve concordância moderada entre o ERF e o ERQ, na estimativa de RCV global em 10 anos. Os escores utilizados podem identificar sinergismo entre as variáveis, e têm comportamento influenciado pela população na qual foram originados. É importante reconhecer a necessidade de escores calibrados para a população brasileira.

Molecular organization of various collagen fragments as revealed by atomic force microscopy and diffusion-ordered NMR spectroscopy.

PubMed

Stötzel, Sabine; Schurink, Marloes; Wienk, Hans; Siebler, Uschi; Burg-Roderfeld, Monika; Eckert, Thomas; Kulik, Bianca; Wechselberger, Rainer; Sewing, Judith; Steinmeyer, Jürgen; Oesser, Steffen; Boelens, Rolf; Siebert, Hans-Christian

2012-09-17

Heterogeneous mixtures of collagen fragments can be used as nutrition supplement or as key ingredients for ointments with therapeutic relevance in wound healing. Some mixtures of collagen fragments are referred to as collagen hydrolysates owing to the production process with hydrolytic enzymes. Since the precise composition of collagen hydrolysates is generally unknown, it is of interest to analyze samples containing various collagen fragments with appropriate biophysical methods. Any product optimization without a profound knowledge concerning the size and the molecular weight distribution of its components is nearly impossible. It turned out that a combination of AFM methods with NMR techniques is exceptionally suited to examine the size range and the aggregation behavior of the collagen fragments in the hydrolysates of fish, jellyfish, chicken, porcine and bovine collagen. Supported by molecular modeling calculations, the AFM and NMR experiments provide a detailed knowledge about the composition of collagen hydrolysates and collagen ointments. Furthermore, the data allow a correlation between the size of the fragments and their potential bioactivity. Copyright © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Degree Of Diminution In Vagal-Cardiac Activity Predicts Sudden Death In Familial Dysautonomia When Resting Tachycardia Is Absent

NASA Technical Reports Server (NTRS)

Schlegel, T. T.; Marthol, H.; Bucchner, S.; Tutaj, M.; Berlin, D.; Axelrod, F. B.; Hilz, M. J.

2004-01-01

Patients with familial dysautonomia (FD) have an increased risk of sudden death, but sensitive and specific predictors of sudden death in FD are lacking. Methods. We recorded 10-min resting high-fidelity 12-lead ECGs in 14 FD patients and in 14 age/gender-matched healthy subjects and studied 25+ different heart rate variability (HRV) indices for their ability to predict sudden death in the FD patients. Indices studied included those from 4 "nonlinear" HRV techniques (detrended fluctuation analysis, approximate entropy, correlation dimension, and PoincarC analyses). The predictive value of PR, QRS, QTc and JTc intervals, QT dispersion (QTd), beat-to-beat QT and PR interval variability indices (QTVI and PRVI) and 12- lead high frequency QRS ECG (150-250 Hz) were also studied. FD patients and controls (C) differed (Pless than 0.0l) with respect to 20+ of the HRV indices (FD less than C) and with respect to QTVI and PRVI (FDBC) and HF QRS- related root mean squared voltages (FDBC) and reduced amplitude zone counts (FD less than C). They differed less with respect to PR intervals (FD less than C) and JTc intervals (FD greater than C) (P less than 0.05 for both) and did not differ at all with respect to QRS and QTc intervals and to QTd. Within 12 months after study, 2 of the 14 patients succumbed to sudden cardiac arrest. The best predictor of sudden death was the degree of diminution in HRV vagal-cardiac (parasympathetic) parameters such as RMSSD, the SDl of Poincare plots, and HF spectral power. Excluding the two FD patients who had resting tachycardia (HR greater than 100, which confounds traditional HRV analyses), the following criteria were independently 100% sensitive and 100% specific for predicting sudden death in the remaining 12 FD patients during spontaneous breathing: RMSSD less than 13 ms and/or PoincarC SD1 less than 9 ms. In FD patients without supine tachycardia, the degree of diminution in parasympathetic HRV parameters (by high-fidelity ECG) predicts incipient death.

Impaired T-wave amplitude adaptation to heart-rate induced by cardiac deconditioning after 5-days of head-down bed-rest

NASA Astrophysics Data System (ADS)

Caiani, Enrico G.; Pellegrini, Alessandro; Bolea, Juan; Sotaquira, Miguel; Almeida, Rute; Vaïda, Pierre

2013-10-01

The study of QT/RR relationship is important for the clinical evaluation of possible risk of acquired or congenital ventricular tachyarrhythmias. In the hypothesis that microgravity exposure could induce changes in the repolarization mechanisms, our aim was to test if a short 5-days strict 6° head-down bed-rest (HDBR) could induce alterations in the QT/RR relationship and spatial repolarization heterogeneity. Twenty-two healthy men (mean age 31±6) were enrolled as part of the European Space Agency HDBR studies. High fidelity (1000 Hz) 24 h Holter ECG (12-leads, Mortara Instrument) was acquired before (PRE), the last day of HDBR (HDT5), and four days after its conclusion (POST). The night period (23:00-06:30) was selected for analysis. X, Y, Z leads were derived and the vectorcardiogram computed. Selective beat averaging was used to obtain averages of P-QRS-T complexes preceded by the same RR (10 ms bin amplitude, in the range 900-1200 ms). For each averaged waveform (i.e., one for each bin), T-wave maximum amplitude (Tmax), T-wave area (Tarea), RTapex, RTend, ventricular gradient (VG) magnitude and spatial QRS-T angle were computed. Non-parametric Friedman test was applied. Compared to PRE, at HDT5 both RTapex and RTend resulted shortened (-4%), with a decrease in T-wave amplitude (-8%) and area (-13%). VG was diminished by 10%, and QRS-T angle increased by 14°. At POST, QT duration and area parameters, as well as QRS-T angle were restored while Tmax resulted larger than PRE (+5%) and VG was still decreased by 3%. Also, a marked loss in strength of the linear regression with RR was found at HDT5 in Tmax and Tarea, that could represent a new dynamic marker of increased risk for life-threatening arrhythmias. Despite the short-term HDBR, ventricular repolarization during the night period was affected. This should be taken into account in astronauts for risk assessment during space flight.

A vector-free ECG interpretation with P, QRS & T waves as unbalanced transitions between stable configurations of the heart electric field during P-R, S-T & T-P segments

PubMed Central

2014-01-01

Since cell membranes are weak sources of electrostatic fields, this ECG interpretation relies on the analogy between cells and electrets. It is here assumed that cell-bound electric fields unite, reach the body surface and the surrounding space and form the thoracic electric field that consists from two concentric structures: the thoracic wall and the heart. If ECG leads measure differences in electric potentials between skin electrodes, they give scalar values that define position of the electric field center along each lead. Repolarised heart muscle acts as a stable positive electric source, while depolarized heart muscle produces much weaker negative electric field. During T-P, P-R and S-T segments electric field is stable, only subtle changes are detectable by skin electrodes. Diastolic electric field forms after ventricular depolarization (T-P segments in the ECG recording). Telediastolic electric field forms after the atria have been depolarized (P-Q segments in the ECG recording). Systolic electric field forms after the ventricular depolarization (S-T segments in the ECG recording). The three ECG waves (P, QRS and T) can then be described as unbalanced transitions of the heart electric field from one stable configuration to the next and in that process the electric field center is temporarily displaced. In the initial phase of QRS, the rapidly diminishing septal electric field makes measured potentials dependent only on positive charges of the corresponding parts of the left and the right heart that lie within the lead axes. If more positive charges are near the "DOWN" electrode than near the "UP" electrode, a Q wave will be seen, otherwise an R wave is expected. Repolarization of the ventricular muscle is dampened by the early septal muscle repolarization that reduces deflection of T waves. Since the "UP" electrode of most leads is near the usually larger left ventricle muscle, T waves are in these leads positive, although of smaller amplitude and longer duration than the QRS wave in the same lead. The proposed interpretation is applied to bundle branch blocks, fascicular (hemi-) blocks and changes during heart muscle ischemia. PMID:24506945

Advanced Electrocardiography Can Identify Occult Cardiomyopathy in Doberman Pinschers

NASA Technical Reports Server (NTRS)

Spiljak, M.; Petric, A. Domanjko; Wilberg, M.; Olsen, L. H.; Stepancic, A.; Schlegel, T. T.; Starc, V.

2011-01-01

Recently, multiple advanced resting electrocardiographic (A-ECG) techniques have improved the diagnostic value of short-duration ECG in detection of dilated cardiomyopathy (DCM) in humans. This study investigated whether 12-lead A-ECG recordings could accurately identify the occult phase of DCM in dogs. Short-duration (3-5 min) high-fidelity 12-lead ECG recordings were obtained from 31 privately-owned, clinically healthy Doberman Pinschers (5.4 +/- 1.7 years, 11/20 males/females). Dogs were divided into 2 groups: 1) 19 healthy dogs with normal echocardiographic M-mode measurements: left ventricular internal diameter in diastole (LVIDd . 47mm) and in systole (LVIDs . 38mm) and normal 24-hour ECG recordings (<50 ventricular premature complexes, VPCs); and 2) 12 dogs with occult DCM: 11/12 dogs had increased M-mode measurements (LVIDd . 49mm and/or LVIDs . 40mm) and 5/11 dogs had also >100 VPCs/24h; 1/12 dogs had only abnormal 24-hour ECG recordings (>100 VPCs/24h). ECG recordings were evaluated via custom software programs to calculate multiple parameters of high-frequency (HF) QRS ECG, heart rate variability, QT variability, waveform complexity and 3-D ECG. Student's t-tests determined 19 ECG parameters that were significantly different (P < 0.05) between groups. Principal component factor analysis identified a 5-factor model with 81.4% explained variance. QRS dipolar and non-dipolar voltages, Cornell voltage criteria and QRS waveform residuum were increased significantly (P < 0.05), whereas mean HF QRS amplitude was decreased significantly (P < 0.05) in dogs with occult DCM. For the 5 selected parameters the prediction of occult DCM was performed using a binary logistic regression model with Chi-square tested significance (P < 0.01). ROC analyses showed that the five selected ECG parameters could identify occult ECG with sensitivity 89% and specificity 83%. Results suggest that 12-lead A-ECG might improve diagnostic value of short-duration ECG in earlier detection of canine DCM as five selected ECG parameters can with reasonable accuracy identify occult DCM in Doberman Pinschers. Future extensive clinical studies need to clarify if 12-lead A-ECG could be useful as an additional screening test for canine DCM.

Non-ideal magnetohydrodynamic simulations of the two-stage fragmentation model for cluster formation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bailey, Nicole D.; Basu, Shantanu, E-mail: N.Bailey@leeds.ac.uk, E-mail: basu@uwo.ca

2014-01-01

We model molecular cloud fragmentation with thin-disk, non-ideal magnetohydrodynamic simulations that include ambipolar diffusion and partial ionization that transitions from primarily ultraviolet-dominated to cosmic-ray-dominated regimes. These simulations are used to determine the conditions required for star clusters to form through a two-stage fragmentation scenario. Recent linear analyses have shown that the fragmentation length scales and timescales can undergo a dramatic drop across the column density boundary that separates the ultraviolet- and cosmic-ray-dominated ionization regimes. As found in earlier studies, the absence of an ionization drop and regular perturbations leads to a single-stage fragmentation on pc scales in transcritical clouds, somore » that the nonlinear evolution yields the same fragment sizes as predicted by linear theory. However, we find that a combination of initial transcritical mass-to-flux ratio, evolution through a column density regime in which the ionization drop takes place, and regular small perturbations to the mass-to-flux ratio is sufficient to cause a second stage of fragmentation during the nonlinear evolution. Cores of size ∼0.1 pc are formed within an initial fragment of ∼pc size. Regular perturbations to the mass-to-flux ratio also accelerate the onset of runaway collapse.« less

Helium diffusion parameters of hematite from a single-diffusion-domain crystal

NASA Astrophysics Data System (ADS)

Farley, K. A.

2018-06-01

This contribution reports new parameters for helium diffusion in hematite useful for interpretation of cosmogenic 3He and radiogenic 4He chronometry. Fragments of a coarse, euhedral single crystal of hematite from Minas Gerais, Brazil were subjected to bulk step-heating helium diffusion experiments after proton irradiation to make a uniform distribution of 3He. Aliquots of three different grain sizes ranging from ∼300 to ∼700 μm in equivalent-sphere radius yielded helium diffusion activation energies Ea ∼ 170 kJ/mol, very similar to previous estimates for Ea in hematite. Uniquely in this specimen, diffusivity varies with the dimensions of the analyzed fragments in precisely the fashion expected if the diffusion domain corresponds to the physical grain. This contrasts with previous studies that concluded that the analyzed hematites consist of polycrystalline aggregates in which helium migration is governed by the size distribution of the constituent crystallites. These new data permit a direct estimate of the helium diffusivity at infinite temperature for hematite of ln(Do) = -0.66 ± 0.35 in cm2/s. The major implication of the new diffusion parameters is that hematite is very retentive of helium even at very small crystal sizes. For example, a 20 nm radius hematite crystal, at the smallest end of the size range so far described in dated polycrystalline hematite specimens, will retain more than 99% of its ingrown He over 1 Myr at 30 °C, and more than 90% over 100 Myr. Under most conditions, hematite is close to quantitatively helium-retentive on the Earth's surface, simplifying radiogenic and cosmogenic helium dating of this phase. In a system cooling at 10 °C/Myr, the 20 nm hematite crystal has a He closure temperature of ∼70 °C, similar to a typical ∼100 μm apatite crystal. Helium is likely held tightly in hematite owing to its dense hexagonal closest packing structure and absence of migration-enhancing channels. The isostructural minerals corundum and ilmenite are likely to be similarly helium retentive.

Disintegration phenomena in Comet West

NASA Technical Reports Server (NTRS)

Sekanina, Z.

1976-01-01

Two peculiarities of Comet West, the multiple splitting of the nucleus as seen in telescope observations and the complex structure of the dust tail, are discussed. A method of analysis based on the premise that the observed rate of separation of a fragment from the principal nucleus is determined by the difference in effective solar attraction acting on the bodies is applied to investigate the motion of the four fragments that separated from the nucleus of Comet West. The predicted motion of the fragments is in good agreement with available observations. It is suggested that the 'synchronic' bands of the dust tail consist of tiny fragments from relatively large particles that burst after release from the comet. The unusual orientation of these bands and their high surface brightness relative to the diffuse tail are explained by a sudden increase in the particle acceleration and in the total scattering surface as the result of the disintegration of the larger particles.

Molecular clouds in galaxies with different Z - Fragmentation of diffuse clouds driven by opacity

NASA Technical Reports Server (NTRS)

Franco, Jose; Cox, Donald P.

1986-01-01

Molecular clouds are formed from diffuse interstellar clouds when the external ultraviolet radiation field is prevented from penetrating into the cloud. The opacity is provided mainly by dust grains and the required column density to the cloud center is larger than about 5 x 10 to the 20th (solar Z/Z)/sq cm. This high-opacity criterion could have a significant impact on the radial trends observed in spiral galaxies, and on the distinctions between spiral and dwarf irregular galaxies.

Coagulation-fragmentation for a finite number of particles and application to telomere clustering in the yeast nucleus

NASA Astrophysics Data System (ADS)

Hozé, Nathanaël; Holcman, David

2012-01-01

We develop a coagulation-fragmentation model to study a system composed of a small number of stochastic objects moving in a confined domain, that can aggregate upon binding to form local clusters of arbitrary sizes. A cluster can also dissociate into two subclusters with a uniform probability. To study the statistics of clusters, we combine a Markov chain analysis with a partition number approach. Interestingly, we obtain explicit formulas for the size and the number of clusters in terms of hypergeometric functions. Finally, we apply our analysis to study the statistical physics of telomeres (ends of chromosomes) clustering in the yeast nucleus and show that the diffusion-coagulation-fragmentation process can predict the organization of telomeres.

Classification of ECG signal with Support Vector Machine Method for Arrhythmia Detection

NASA Astrophysics Data System (ADS)

Turnip, Arjon; Ilham Rizqywan, M.; Kusumandari, Dwi E.; Turnip, Mardi; Sihombing, Poltak

2018-03-01

An electrocardiogram is a potential bioelectric record that occurs as a result of cardiac activity. QRS Detection with zero crossing calculation is one method that can precisely determine peak R of QRS wave as part of arrhythmia detection. In this paper, two experimental scheme (2 minutes duration with different activities: relaxed and, typing) were conducted. From the two experiments it were obtained: accuracy, sensitivity, and positive predictivity about 100% each for the first experiment and about 79%, 93%, 83% for the second experiment, respectively. Furthermore, the feature set of MIT-BIH arrhythmia using the support vector machine (SVM) method on the WEKA software is evaluated. By combining the available attributes on the WEKA algorithm, the result is constant since all classes of SVM goes to the normal class with average 88.49% accuracy.

A Wearable Cardiac Monitor for Long-Term Data Acquisition and Analysis

PubMed Central

Winokur, Eric S.; Delano, Maggie K.; Sodini, Charles G.

2015-01-01

A low-power wearable ECG monitoring system has been developed entirely from discrete electronic components and a custom PCB. This device removes all loose wires from the system and minimizes the footprint on the user. The monitor consists of five electrodes, which allow a cardiologist to choose from a variety of possible projections. Clinical tests to compare our wearable monitor with a commercial clinical ECG recorder are conducted on ten healthy adults under different ambulatory conditions, with nine of the datasets used for analysis. Data from both monitors were synchronized and annotated with PhysioNet's waveform viewer WAVE (physionet.org) [1]. All gold standard annotations are compared to the results of the WQRS detection algorithm [2] provided by PhysioNet. QRS sensitivity and QRS positive predictability are extracted from both monitors to validate the wearable monitor. PMID:22968205

[Wide QRS tachycardia preceded by pacemaker spikes].

PubMed

Romero, M; Aranda, A; Gómez, F J; Jurado, A

2014-04-01

The differential diagnosis and therapeutic management of wide QRS tachycardia preceded by pacemaker spike is presented. The pacemaker-mediated tachycardia, tachycardia fibrillo-flutter in patients with pacemakers, and runaway pacemakers, have a similar surface electrocardiogram, but respond to different therapeutic measures. The tachycardia response to the application of a magnet over the pacemaker could help in the differential diagnosis, and in some cases will be therapeutic, as in the case of a tachycardia-mediated pacemaker. Although these conditions are diagnosed and treated in hospitals with catheterization laboratories using the application programmer over the pacemaker, patients presenting in primary care clinic and emergency forced us to make a diagnosis and treat the haemodynamically unstable patient prior to referral. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

ECG-ViEW II, a freely accessible electrocardiogram database

PubMed Central

Park, Man Young; Lee, Sukhoon; Jeon, Min Seok; Yoon, Dukyong; Park, Rae Woong

2017-01-01

The Electrocardiogram Vigilance with Electronic data Warehouse II (ECG-ViEW II) is a large, single-center database comprising numeric parameter data of the surface electrocardiograms of all patients who underwent testing from 1 June 1994 to 31 July 2013. The electrocardiographic data include the test date, clinical department, RR interval, PR interval, QRS duration, QT interval, QTc interval, P axis, QRS axis, and T axis. These data are connected with patient age, sex, ethnicity, comorbidities, age-adjusted Charlson comorbidity index, prescribed drugs, and electrolyte levels. This longitudinal observational database contains 979,273 electrocardiograms from 461,178 patients over a 19-year study period. This database can provide an opportunity to study electrocardiographic changes caused by medications, disease, or other demographic variables. ECG-ViEW II is freely available at http://www.ecgview.org. PMID:28437484

Optical polarization properties of InAs/InP quantum dot and quantum rod nanowires.

PubMed

Anufriev, Roman; Barakat, Jean-Baptiste; Patriarche, Gilles; Letartre, Xavier; Bru-Chevallier, Catherine; Harmand, Jean-Christophe; Gendry, Michel; Chauvin, Nicolas

2015-10-02

The emission polarization of single InAs/InP quantum dot (QD) and quantum rod (QR) nanowires is investigated at room temperature. Whereas the emission of the QRs is mainly polarized parallel to the nanowire axis, the opposite behavior is observed for the QDs. These optical properties can be explained by a combination of dielectric effects related to the nanowire geometry and to the configuration of the valence band in the nanostructure. A theoretical model and finite difference in time domain calculations are presented to describe the impact of the nanowire and the surroundings on the optical properties of the emitter. Using this model, the intrinsic degree of linear polarization of the two types of emitters is extracted. The strong polarization anisotropies indicate a valence band mixing in the QRs but not in the QDs.

Identification of QTLs for resistant starch and total alkaloid content in brown and polished rice.

PubMed

Zeng, Y W; Sun, D; Du, J; Pu, X Y; Yang, S M; Yang, X M; Yang, T; Yang, J Z

2016-07-29

An F3 population consisting of 117 F2:3 families derived from a cross between two varieties of rice, Gongmi No. 3 and Diantun 502, with a large difference in their resistant starch and total alkaloid content, was used for quantitative trait locus (QTL) mapping. Two QTLs of resistant starch for rice (qRS7-1, qRS7-2) were identified in a linkage group on chromosome 7, which could explain phenotypic variance from 7.6 to 17.3%, due to additive effects for resistant starch from Gongmi No. 3 or over-dominance effects for qRS7-2 of the marker interval (RM3404-RM478) on chromosome 7 from Gongmi No. 3, accounting for 13.8-17.3% of the phenotypic variance. Two QTLs of total alkaloids for brown rice (qALb7-1, qALb7-2) were identified in the same linkage group, which could explain phenotypic variance from 7.7 and 19.3%, respectively, due to dominance or over-dominance effects for total alkaloids on chromosome 7 from Diantun 502. To our knowledge, these are the first QTLs to be identified, which are related to resistant starch and total alkaloid content in rice. These results are beneficial for understanding the genetic basis of, as well as for developing markers linked with, resistant starch and total alkaloids of functional components for marker-assisted selection breeding in rice.

Effect of gender on computerized electrocardiogram measurements in college athletes.

PubMed

Mandic, Sandra; Fonda, Holly; Dewey, Frederick; Le, Vy-van; Stein, Ricardo; Wheeler, Matt; Ashley, Euan A; Myers, Jonathan; Froelicher, Victor F

2010-06-01

Broad criteria for classifying an electrocardiogram (ECG) as abnormal and requiring additional testing prior to participating in competitive athletics have been recommended for the preparticipation examination (PPE) of athletes. Because these criteria have not considered gender differences, we examined the effect of gender on the computerized ECG measurements obtained on Stanford student athletes. Currently available computer programs require a basis for "normal" in athletes of both genders to provide reliable interpretation. During the 2007 PPE, computerized ECGs were recorded and analyzed on 658 athletes (54% male; mean age, 19 +/- 1 years) representing 22 sports. Electrocardiogram measurements included intervals and durations in all 12 leads to calculate 12-lead voltage sums, QRS amplitude and QRS area, spatial vector length (SVL), and the sum of the R wave in V5 and S wave in V2 (RSsum). By computer analysis, male athletes had significantly greater QRS duration, PR interval, Q-wave duration, J-point amplitude, and T-wave amplitude, and shorter QTc interval compared with female athletes (all P < 0.05). All ECG indicators of left ventricular electrical activity were significantly greater in males. Although gender was consistently associated with indices of atrial and ventricular electrical activity in multivariable analysis, ECG measurements correlated poorly with body dimensions. Significant gender differences exist in ECG measurements of college athletes that are not explained by differences in body size. Our tables of "normal" computerized gender-specific measurements can facilitate the development of automated ECG interpretation for screening young athletes.

Members of the emergency medical team may have difficulty diagnosing rapid atrial fibrillation in Wolff-Parkinson-White syndrome.

PubMed

Koźluk, Edward; Timler, Dariusz; Zyśko, Dorota; Piątkowska, Agnieszka; Grzebieniak, Tomasz; Gajek, Jacek; Gałązkowski, Robert; Fedorowski, Artur

2015-01-01

Atrial fibrillation (AF) in patients with Wolff-Parkinson-White (WPW) syndrome is potentially life-threatening as it may deteriorate into ventricular fibrillation. The aim of this study was to assess whether the emergency medical team members are able to diagnose AF with a rapid ventricular response due to the presence of atrioventricular bypass tract in WPW syndrome. The study group consisted of 316 participants attending a national congress of emergency medicine. A total of 196 questionnaires regarding recognition and management of cardiac arrhythmias were distributed. The assessed part presented a clinical scenario with a young hemodynamically stable man who had a 12-lead electrocardiogram performed in the past with signs of pre-excitation, and who presented to the emergency team with an irregular broad QRS-complex tachycardia. A total of 71 questionnaires were filled in. Only one responder recognized AF due to WPW syndrome, while 5 other responders recognized WPW syndrome and paroxysmal supraventricular tachycardia or broad QRS-complex tachycardia. About 20% of participants did not select any diagnosis, pointing out a method of treatment only. The most common diagnosis found in the survey was ventricular tachycardia/broad QRS-complex tachycardia marked by approximately a half of the participants. Nearly 18% of participants recognized WPW syndrome, whereas AF was recognized by less than 10% of participants. Members of emergency medical teams have limited skills for recognizing WPW syndrome with rapid AF, and ventricular tachycardia is the most frequent incorrect diagnosis.

The effect of diffuse basis functions on valence bond structural weights

NASA Astrophysics Data System (ADS)

Galbraith, John Morrison; James, Andrew M.; Nemes, Coleen T.

2014-03-01

Structural weights and bond dissociation energies have been determined for H-F, H-X, and F-X molecules (-X = -OH, -NH2, and -CH3) at the valence bond self-consistent field (VBSCF) and breathing orbital valence bond (BOVB) levels of theory with the aug-cc-pVDZ and 6-31++G(d,p) basis sets. At the BOVB level, the aug-cc-pVDZ basis set yields a counterintuitive ordering of ionic structural weights when the initial heavy atom s-type basis functions are included. For H-F, H-OH, and F-X, the ordering follows chemical intuition when these basis functions are not included. These counterintuitive weights are shown to be a result of the diffuse polarisation function on one VB fragment being spatially located, in part, on the other VB fragment. Except in the case of F-CH3, this problem is corrected with the 6-31++G(d,p) basis set. The initial heavy atom s-type functions are shown to make an important contribution to the VB orbitals and bond dissociation energies and, therefore, should not be excluded. It is recommended to not use diffuse basis sets in valence bond calculations unless absolutely necessary. If diffuse basis sets are needed, the 6-31++G(d,p) basis set should be used with caution and the structural weights checked against VBSCF values which have been shown to follow the expected ordering in all cases.

Visualization of gas flow and diffusion in porous media

PubMed Central

Kaiser, Lana G.; Meersmann, Thomas; Logan, John W.; Pines, Alexander

2000-01-01

The transport of gases in porous materials is a crucial component of many important processes in science and technology. In the present work, we demonstrate how magnetic resonance microscopy with continuous flow laser-polarized noble gases makes it possible to “light up” and thereby visualize, with unprecedented sensitivity and resolution, the dynamics of gases in samples of silica aerogels and zeolite molecular sieve particles. The “polarization-weighted” images of gas transport in aerogel fragments are correlated to the diffusion coefficient of xenon obtained from NMR pulsed-field gradient experiments. The technique provides a unique means of studying the combined effects of flow and diffusion in systems with macroscopic dimensions and microscopic internal pore structure. PMID:10706617

Analysis of ligand-protein exchange by Clustering of Ligand Diffusion Coefficient Pairs (CoLD-CoP)

NASA Astrophysics Data System (ADS)

Snyder, David A.; Chantova, Mihaela; Chaudhry, Saadia

2015-06-01

NMR spectroscopy is a powerful tool in describing protein structures and protein activity for pharmaceutical and biochemical development. This study describes a method to determine weak binding ligands in biological systems by using hierarchic diffusion coefficient clustering of multidimensional data obtained with a 400 MHz Bruker NMR. Comparison of DOSY spectrums of ligands of the chemical library in the presence and absence of target proteins show translational diffusion rates for small molecules upon interaction with macromolecules. For weak binders such as compounds found in fragment libraries, changes in diffusion rates upon macromolecular binding are on the order of the precision of DOSY diffusion measurements, and identifying such subtle shifts in diffusion requires careful statistical analysis. The "CoLD-CoP" (Clustering of Ligand Diffusion Coefficient Pairs) method presented here uses SAHN clustering to identify protein-binders in a chemical library or even a not fully characterized metabolite mixture. We will show how DOSY NMR and the "CoLD-CoP" method complement each other in identifying the most suitable candidates for lysozyme and wheat germ acid phosphatase.

Valley- and spin-polarized oscillatory magneto-optical absorption in monolayer MoS2 quantum rings

NASA Astrophysics Data System (ADS)

Oliveira, D.; Villegas-Lelovsky, L.; Soler, M. A. G.; Qu, Fanyao

2018-03-01

Besides optical valley selectivity, strong spin-orbit interaction along with Berry curvature effects also leads to unconventional valley- and spin-polarized Landau levels in monolayer transition metal dichalcogenides (TMDCs) under a perpendicular magnetic field. We find that these unique properties are inherited to the magneto-optical absorption spectrum of the TMDC quantum rings (QRs). In addition, it is robust against variation of the magnetic flux and of the QR geometry. In stark contrast to the monolayer bulk material, the MoS2 QRs manifest themselves in both the optical valley selectivity and unprecedented size tunability of the frequency of the light absorbed. We also find that when the magnetic field setup is changed, the phase transition from Aharonov-Bohm (AB) quantum interference to aperiodic oscillation of magneto-optical absorption spectrum takes place. The exciton spectrum in a realistic finite thickness MoS2 QR is also discussed.

Electrocardiogram Changes with Acute Alcohol Intoxication: A Systematic Review.

PubMed

Raheja, Hitesh; Namana, Vinod; Chopra, Kirti; Sinha, Ankur; Gupta, Sushilkumar Satish; Kamholz, Stephan; Moskovits, Norbert; Shani, Jacob; Hollander, Gerald

2018-01-01

Acute alcohol intoxication has been associated with cardiac arrhythmias but the electrocardiogram (ECG) changes associated with acute alcohol intoxication are not well defined in the literature. Highlight the best evidence regarding the ECG changes associated with acute alcohol intoxication in otherwise healthy patients and the pathophysiology of the changes. A literature search was carried out; 4 studies relating to ECG changes with acute alcohol intoxication were included in this review. Of the total 141 patients included in the review, 90 (63.8%) patients had P-wave prolongation, 80 (56%) patients had QTc prolongation, 19 (13.5%) patients developed T-wave abnormalities, 10 (7%) patients had QRS complex prolongation, 3 (2.12%) patients developed ST-segment depressions. The most common ECG changes associated with acute alcohol intoxication are (in decreasing order of frequency) P-wave and QTc prolongation, followed by T-wave abnormalities and QRS complex prolongation. Mostly, these changes are completely reversible.

Magnetocardiography measurements with 4He vector optically pumped magnetometers at room temperature

NASA Astrophysics Data System (ADS)

Morales, S.; Corsi, M. C.; Fourcault, W.; Bertrand, F.; Cauffet, G.; Gobbo, C.; Alcouffe, F.; Lenouvel, F.; Le Prado, M.; Berger, F.; Vanzetto, G.; Labyt, E.

2017-09-01

In this paper, we present a proof of concept study which demonstrates for the first time the possibility of recording magnetocardiography (MCG) signals with 4He vector optically pumped magnetometers (OPM) operated in a gradiometer mode. Resulting from a compromise between sensitivity, size and operability in a clinical environment, the developed magnetometers are based on the parametric resonance of helium in a zero magnetic field. Sensors are operated at room temperature and provide a tri-axis vector measurement of the magnetic field. Measured sensitivity is around 210 f T (√Hz)-1 in the bandwidth (2 Hz; 300 Hz). MCG signals from a phantom and two healthy subjects are successfully recorded. Human MCG data obtained with the OPMs are compared to reference electrocardiogram recordings: similar heart rates, shapes of the main patterns of the cardiac cycle (P/T waves, QRS complex) and QRS widths are obtained with both techniques.

Comparative optical study of epitaxial InGaAs quantum rods grown with As{sub 2} and As{sub 4} sources

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nedzinskas, Ramūnas; Čechavičius, Bronislovas; Kavaliauskas, Julius

2013-12-04

Photoreflectance and photoluminescence (PL) spectroscopies are used to examine the optical properties and electronic structure of InGaAs quantum rods (QRs), embedded within InGaAs quantum well (QW). The nanostructures studied were grown by molecular beam epitaxy using As{sub 2} or As{sub 4} sources. The impact of As source on spectral features associated with interband optical transitions in the QRs and the surrounding QW are demonstrated. A red shift of the QR- and a blue shift of the QW-related optical transitions, along with a significant increase in PL intensity, have been observed if an As{sub 4} source is used. The changes inmore » optical properties are attributed mainly to carrier confinement effects caused by variation of In content contrast between the QR material and the surrounding well.« less

Electronic structure calculations of PbS quantum rods and tubes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pimachev, Artem; Dahnovsky, Yuri, E-mail: yurid@uwyo.edu

2014-01-28

We study absorption spectra, optical and HOMO-LUMO gaps, and the density of states for PbS quantum rods (QRs) and tubes (QTs). We find some similarities and also differences in QR and QT properties. For both QRs and QTs, the optical and HOMO-LUMO gaps reach the plateaus for small lengths. We find that tubes are as stable as rods. The optical spectra exhibit a peak that can be due to the electron-hole interaction or be a prototype of an S{sub e}–S{sub h} transition in the effective mass approximation. We also calculate the density of states by the density functional theory (DFT)more » and time-dependent density functional theory (TDDFT) methods. The TDDFT density of states function is shifted towards the red side by 0.5 eV indicating the strong e-h interaction.« less

Dust evolution, a global view: II. Top-down branching, nanoparticle fragmentation and the mystery of the diffuse interstellar band carriers

PubMed Central

2016-01-01

The origin of the diffuse interstellar bands (DIBs), one of the longest-standing mysteries of the interstellar medium (ISM), is explored within the framework of The Heterogeneous dust Evolution Model for Interstellar Solids (THEMIS). The likely nature of the DIB carriers and their evolution is here explored within the framework of the structures and sub-structures inherent to doped hydrogenated amorphous carbon grains in the ISM. Based on the natural aromatic-rich moieties (asphaltenes) recovered from coal and oil, the likely structure of their interstellar analogues is investigated within the context of the diffuse band problem. It is here proposed that the top-down evolution of interstellar carbonaceous grains, and, in particular, a-C(:H) nanoparticles, is at the heart of the formation and evolution of the DIB carriers and their associations with small molecules and radicals, such as C2, C3, CH and CN. It is most probable that the DIBs are carried by dehydrogenated, ionized, hetero-cyclic, olefinic and aromatic-rich moieties that form an integral part of the contiguous structure of hetero-atom-doped hydrogenated amorphous carbon nanoparticles and their daughter fragmentation products. Within this framework, it is proposed that polyene structures in all their variants could be viable DIB carrier candidates. PMID:28083089

Dust evolution, a global view: II. Top-down branching, nanoparticle fragmentation and the mystery of the diffuse interstellar band carriers

NASA Astrophysics Data System (ADS)

Jones, A. P.

2016-12-01

The origin of the diffuse interstellar bands (DIBs), one of the longest-standing mysteries of the interstellar medium (ISM), is explored within the framework of The Heterogeneous dust Evolution Model for Interstellar Solids (THEMIS). The likely nature of the DIB carriers and their evolution is here explored within the framework of the structures and sub-structures inherent to doped hydrogenated amorphous carbon grains in the ISM. Based on the natural aromatic-rich moieties (asphaltenes) recovered from coal and oil, the likely structure of their interstellar analogues is investigated within the context of the diffuse band problem. It is here proposed that the top-down evolution of interstellar carbonaceous grains, and, in particular, a-C(:H) nanoparticles, is at the heart of the formation and evolution of the DIB carriers and their associations with small molecules and radicals, such as C2, C3, CH and CN. It is most probable that the DIBs are carried by dehydrogenated, ionized, hetero-cyclic, olefinic and aromatic-rich moieties that form an integral part of the contiguous structure of hetero-atom-doped hydrogenated amorphous carbon nanoparticles and their daughter fragmentation products. Within this framework, it is proposed that polyene structures in all their variants could be viable DIB carrier candidates.

Controlled formation of GeSi nanostructures on pillar-patterned Si substrate

NASA Astrophysics Data System (ADS)

Zhou, Tong; Zeng, Ceng; Fan, Yongliang; Jiang, Zuimin; Xia, Jinsong; Zhong, Zhenyang; Fudan University Team; Huazhong University of Science; Technology Collaboration

2015-03-01

GeSi quantum nanostructures (QNs) have potential applications in optoelectronic devices due to their unique properties and compatibility with the sophisticated Si technology. However, the disadvantages of poor quantum efficiency of the GeSi QNs on flat Si (001) substrates hinder their optoelectronic applications. Today, numerous growth strategies have been proposed to control the formation of GeSi QNs in hope of improving the optoelectronic performances. One of the ways is to fabricate GeSi QNs on patterned substrates, where the GeSi QNs can be greatly manipulated in aspects of size, shape, composition, orientation and arrangement. Here, self-assembled GeSi QNs on periodic Si (001) sub-micro pillars (SPMs) are systematically studied. By controlling the growth conditions and the diameters of the SPMs, different GeSi QNs, including circularly arranged quantum dots (QDs), quantum rings (QRs), and quantum dot molecules (QDMs), are realized at the top edge of SMPs. Meanwhile, fourfold symmetric GeSi QDMs can be also obtained at the base edges of the SPMs. The promising features of self-assembled GeSi QNs are explained in terms of the surface chemical potential, which disclose the critical effect of surface morphology on the diffusion and the aggregation of Ge adatoms.

Fragmentation, rings and coarsening: structure and transformations of nanocrystal aggregate networks on a liquid surface

NASA Astrophysics Data System (ADS)

Yang, Bo; Scheidtmann, Jens; Mayer, Joachim; Wuttig, Matthias; Michely, Thomas

2002-01-01

Deposition of Ag on a silicon oil surface leads to the formation of nm-sized Ag crystals floating on the oil surface. These nanocrystals mutually attract each other, forming strongly branched nanocrystal aggregates and continuous aggregate networks. Transformation processes of such nanocrystal aggregate networks are imaged in situ by optical microscopy. The observations are explained on the basis of a simple model involving diffusion of nanocrystals along aggregate edges and the rupture of branches resulting from branch width fluctuations due to edge diffusion.

Utility of registries for post-marketing evaluation of medicines. A survey of Swedish health care quality registries from a regulatory perspective.

PubMed

Feltelius, Nils; Gedeborg, Rolf; Holm, Lennart; Zethelius, Björn

2017-06-01

The aim of this study was to describe content and procedures in some selected Swedish health care quality registries (QRs) of relevance to regulatory decision-making. A workshop was organized with participation of seven Swedish QRs which subsequently answered a questionnaire regarding registry content on drug treatments and outcomes. Patient populations, coverage, data handling and quality control, as well as legal and ethical aspects are presented. Scientific publications from the QRs are used as a complementary measure of quality and scientific relevance. The registries under study collect clinical data of high relevance to regulatory and health technology agencies. Five out of seven registries provide information on the drug of interest. When applying external quality criteria, we found a high degree of fulfillment, although information on medication was not sufficient to answer all questions of regulatory interest. A notable strength is the option for linkage to the Prescribed Drug Registry and to information on education and socioeconomic status. Data on drugs used during hospitalization were also collected to some extent. Outcome measures collected resemble those used in relevant clinical trials. All registries collected patient-reported outcome measures. The number of publications from the registries was substantial, with studies of appropriate design, including randomized registry trials. Quality registries may provide a valuable source of post-marketing data on drug effectiveness, safety, and cost-effectiveness. Closer collaboration between registries and regulators to improve quality and usefulness of registry data could benefit both regulatory utility and value for health care providers.

Characterization of ventricular depolarization and repolarization changes in a porcine model of myocardial infarction.

PubMed

Romero, Daniel; Ringborn, Michael; Demidova, Marina; Koul, Sasha; Laguna, Pablo; Platonov, Pyotr G; Pueyo, Esther

2012-12-01

In this study, several electrocardiogram (ECG)-derived indices corresponding to both ventricular depolarization and repolarization were evaluated during acute myocardial ischemia in an experimental model of myocardial infarction produced by 40 min coronary balloon inflation in 13 pigs. Significant changes were rapidly observed from minute 4 after the start of coronary occlusion, achieving their maximum values between 11 and 22 min for depolarization and between 9 and 12 min for repolarization indices, respectively. Subsequently, these maximum changes started to decrease during the latter part of the occlusion. Depolarization changes associated with the second half of the QRS complex showed a significant but inverse correlation with the myocardium at risk (MaR) estimated by scintigraphic images. The correlation between MaR and changes of the downward slope of the QRS complex, [Formula: see text], evaluated at the two more relevant peaks observed during the occlusion, was r = -0.75, p < 0.01 and r = -0.79, p < 0.01 for the positive and negative deflections observed in [Formula: see text], temporal evolution, respectively. Repolarization changes, analyzed by evaluation of ST segment elevation at the main observed positive peak, also showed negative, however non-significant correlation with MaR: r = -0.34, p = 0.28. Our results suggest that changes evaluated in the latter part of the depolarization, such as those described by [Formula: see text], which are influenced by R-wave amplitude, QRS width and ST level variations simultaneously, correlate better with the amount of ischemia than other indices evaluated in the earlier part of depolarization or during the ST segment.

Utility of registries for post-marketing evaluation of medicines. A survey of Swedish health care quality registries from a regulatory perspective

PubMed Central

Feltelius, Nils; Gedeborg, Rolf; Holm, Lennart; Zethelius, Björn

2017-01-01

Aim The aim of this study was to describe content and procedures in some selected Swedish health care quality registries (QRs) of relevance to regulatory decision-making. Methods A workshop was organized with participation of seven Swedish QRs which subsequently answered a questionnaire regarding registry content on drug treatments and outcomes. Patient populations, coverage, data handling and quality control, as well as legal and ethical aspects are presented. Scientific publications from the QRs are used as a complementary measure of quality and scientific relevance. Results The registries under study collect clinical data of high relevance to regulatory and health technology agencies. Five out of seven registries provide information on the drug of interest. When applying external quality criteria, we found a high degree of fulfillment, although information on medication was not sufficient to answer all questions of regulatory interest. A notable strength is the option for linkage to the Prescribed Drug Registry and to information on education and socioeconomic status. Data on drugs used during hospitalization were also collected to some extent. Outcome measures collected resemble those used in relevant clinical trials. All registries collected patient-reported outcome measures. The number of publications from the registries was substantial, with studies of appropriate design, including randomized registry trials. Conclusions Quality registries may provide a valuable source of post-marketing data on drug effectiveness, safety, and cost-effectiveness. Closer collaboration between registries and regulators to improve quality and usefulness of registry data could benefit both regulatory utility and value for health care providers. PMID:28276780

Electrocardiographic Characterization of Cardiac Hypertrophy in Mice that Overexpress the ErbB2 Receptor Tyrosine Kinase

PubMed Central

Sysa-Shah, Polina; Sørensen, Lars L; Abraham, M Roselle; Gabrielson, Kathleen L

2015-01-01

Electrocardiography is an important method for evaluation and risk stratification of patients with cardiac hypertrophy. We hypothesized that the recently developed transgenic mouse model of cardiac hypertrophy (ErbB2tg) will display distinct ECG features, enabling WT (wild type) mice to be distinguished from transgenic mice without using conventional PCR genotyping. We evaluated more than 2000 mice and developed specific criteria for genotype determination by using cageside ECG, during which unanesthetized mice were manually restrained for less than 1 min. Compared with those from WT counterparts, the ECG recordings of ErbB2tg mice were characterized by higher P- and R-wave amplitudes, broader QRS complexes, inverted T waves, and ST interval depression. Pearson's correlation matrix analysis of combined WT and ErbB2tg data revealed significant correlation between heart weight and the ECG parameters of QT interval (corrected for heart rate), QRS interval, ST height, R amplitude, P amplitude, and PR interval. In addition, the left ventricular posterior wall thickness as determined by echocardiography correlated with ECG-determined ST height, R amplitude, QRS interval; echocardiographic left ventricular mass correlated with ECG-determined ST height and PR interval. In summary, we have determined phenotypic ECG criteria to differentiate ErbB2tg from WT genotypes in 98.8% of mice. This inexpensive and time-efficient ECG-based phenotypic method might be applied to differentiate between genotypes in other rodent models of cardiac hypertrophy. Furthermore, with appropriate modifications, this method might be translated for use in other species. PMID:26310459

Comparison of Digital 12-Lead ECG and Digital 12-Lead Holter ECG Recordings in Healthy Male Subjects: Results from a Randomized, Double-Blinded, Placebo-Controlled Clinical Trial.

PubMed

Wang, Duolao; Bakhai, Ameet; Arezina, Radivoj; Täubel, Jörg

2016-11-01

Electrocardiogram (ECG) variability is greatly affected by the ECG recording method. This study aims to compare Holter and standard ECG recording methods in terms of central locations and variations of ECG data. We used the ECG data from a double-blinded, placebo-controlled, randomized clinical trial and used a mixed model approach to assess the agreement between two methods in central locations and variations of eight ECG parameters (Heart Rate, PR, QRS, QT, RR, QTcB, QTcF, and QTcI intervals). A total of 34 heathy male subjects with mean age of 25.7 ± 4.78 years were randomized to receive either active drug or placebo. Digital 12-lead ECG and digital 12-lead Holter ECG recordings were performed to assess ECG variability. There are no significant differences in least square mean between the Holter and the standard method for all ECG parameters. The total variance is consistently higher for the Holter method than the standard method for all ECG parameters except for QRS. The intraclass correlation coefficient (ICC) values for the Holter method are consistently lower than those for the standard method for all ECG parameters except for QRS, in particular, the ICC for QTcF is reduced from 0.86 for the standard method to 0.67 for the Holter method. This study suggests that Holter ECGs recorded in a controlled environment are not significantly different but more variable than those from the standard method. © 2016 Wiley Periodicals, Inc.

On the normal scalar ECG. A new classification system considering age, sex and heart position.

PubMed

Lundh, B

1984-01-01

472 randomly selected men and women from the city of Lund were examined for disease in the heart, lungs and for hypertension. 163 men and 194 women who had no symptom or sign of disease were accepted for the further study. The prevalence of various exclusion criterias, such as symptoms and signs of heart disease, lung disease and other diseases which may possibly affect the ECG are reported as well as the distribution of blood pressures in the sample. A computer-averaged standard 12-lead ECG (leads aVL, I, -aVR, II, aVF, III, V1-V6) was recorded. All measurements of ECG-deflections have been made visually using a magnifying glass (6 times). ST-segments were classified according to the Punsar code by independent visual observers as well as by the computer. The mean frontal QRS-axis shifted to the left with advancing age, but the shift was statistically significant only in men. In both men and women there was a leftward shift of the mean frontal QRS-axis with increased weight, increased chest circumference and increased obesity index. The normal range of axis was found to be 0 degrees to 90 degrees in men and +15 degrees to 90 degrees in women. The problems concerning the definition of the electrical heart position is discussed. The concept of a Q-axis is introduced as an alternative way to indicate electrical heart position. There is a statistical significant relationship between the Q-axis and the QRS-axis in the frontal plane, although this relationship is not always apparent in the individual ECG. The presence or absence of a Q-wave in an individual lead was used to denote a lead as being a left ventricular lead or not. Using the Q-wave as a marker of heart position in the individual lead is more practical than to use the QRS-axis or the transitional zone. Duration and amplitude of the Q-wave have been measured. The upper limit of normal duration exceeded 0.03 s in leads aVL and aVF in men but not in women. The R-wave amplitudes proved to vary with age and heart position in men. In women variation of the R-wave amplitude was found with heart position but not with age.(ABSTRACT TRUNCATED AT 400 WORDS)

A 1H NMR method for the analysis of antigen-antibody interactions: binding of a peptide fragment of lysozyme to anti-lysozyme monoclonal antibody.

PubMed

Ito, W; Nishimura, M; Sakato, N; Fujio, H; Arata, Y

1987-09-01

A proton nuclear magnetic resonance (NMR) study is reported of the molecular structural basis of antigen-antibody interactions. An immunologically reactive proteolytic fragment corresponding to one of the antigenic regions on hen egg-white lysozyme (HEL) was used in combination with a monoclonal antibody that recognizes this site. Using spin diffusion, we prepared an antibody in which the magnetization of the antigen binding site was saturated by non-specific nuclear Overhauser effect. Under these conditions the effect of the saturation of the antibody was observed to spread over the peptide fragment through the antigen binding site. On the basis of the results obtained for the intermolecular nuclear Overhauser effect, we discuss how the peptide fragment interacts with the antibody. The side chains of aromatic residues, Trp, Tyr, and His, and of ionic residues, especially Arg, Lys, and Glu, are suggested to be important in the antigen-antibody interaction.

Multinucleon transfer dynamics in heavy-ion collisions near Coulomb-barrier energies

NASA Astrophysics Data System (ADS)

Niu, Fei; Chen, Peng-Hui; Guo, Ya-Fei; Ma, Chun-Wang; Feng, Zhao-Qing

2017-12-01

Multinucleon transfer reactions near barrier energies have been investigated with a multistep model based on the dinuclear system (DNS) concept, in which the capture of two colliding nuclei, the transfer dynamics, and the deexcitation process of primary fragments are described by an analytical formula, diffusion theory, and a statistical model, respectively. The nucleon transfer takes place after forming the DNS and is coupled to the dissipation of relative motion energy and angular momentum by solving a set of microscopically derived master equations within the potential energy surface. Specific reactions of Ca,4840+124Sn , 40Ca(40Ar,58Ni)+232Th , 40Ca(58Ni)+238U , and Ca,4840(58Ni)+248Cm near barrier energies are investigated. It is found that fragments are produced by multinucleon transfer reactions with maximal yields along the β -stability line. The isospin relaxation is particularly significant in the process of fragment formation. The incident energy dependence of heavy target-like fragments in the reaction of 58Ni+248Cm is analyzed thoroughly.

(1)H NMR spectroscopy for profiling complex carbohydrate mixtures in non-fractionated beer.

PubMed

Petersen, Bent O; Nilsson, Mathias; Bøjstrup, Marie; Hindsgaul, Ole; Meier, Sebastian

2014-05-01

A plethora of biological and biotechnological processes involve the enzymatic remodelling of carbohydrates in complex mixtures whose compositions affect both the processes and products. In the current study, we employed high-resolution (1)H NMR spectroscopy for the analysis of cereal-derived carbohydrate mixtures as exemplified on six beer samples of different styles. Structural assignments of more than 50 carbohydrate moieties were obtained using (1)H1-(1)H2 groups as structural reporters. Spectroscopically resolved carbohydrates include more than ''20 different'' small carbohydrates with more than 38 isomeric forms in addition to cereal polysaccharide fragments with suspected organoleptic and prebiotic function. Structural motifs at the cleavage sites of starch, β-glucan and arabinoxylan fragments were identified, showing different extent and specificity of enzymatic polysaccharide cleavage during the production of different beer samples. Diffusion ordered spectroscopy supplied independent size information for the characterisation and identification of polysaccharide fragments, indicating the presence especially of high molecular weight arabinoxylan fragments in the final beer. Copyright © 2013 Elsevier Ltd. All rights reserved.

Modeling and experimental examination of water level effects on radon exhalation from fragmented uranium ore.

PubMed

Ye, Yong-Jun; Dai, Xin-Tao; Ding, De-Xin; Zhao, Ya-Li

2016-12-01

In this study, a one-dimensional steady-state mathematical model of radon transport in fragmented uranium ore was established according to Fick's law and radon transfer theory in an air-water interface. The model was utilized to obtain an analytical solution for radon concentration in the air-water, two-phase system under steady state conditions, as well as a corresponding radon exhalation rate calculation formula. We also designed a one-dimensional experimental apparatus for simulating radon diffusion migration in the uranium ore with various water levels to verify the mathematical model. The predicted results were in close agreement with the measured results, suggesting that the proposed model can be readily used to determine radon concentrations and exhalation rates in fragmented uranium ore with varying water levels. Copyright © 2016. Published by Elsevier Ltd.

Natural age dispersion arising from the analysis of broken crystals. Part I: Theoretical basis and implications for the apatite (U-Th)/He thermochronometer

NASA Astrophysics Data System (ADS)

Brown, Roderick W.; Beucher, Romain; Roper, Steven; Persano, Cristina; Stuart, Fin; Fitzgerald, Paul

2013-12-01

Over the last decade major progress has been made in developing both the theoretical and practical aspects of apatite (U-Th)/He thermochronometry and it is now standard practice, and generally seen as best practice, to analyse single grain aliquots. These individual prismatic crystals are often broken and are fragments of larger crystals that have broken during mineral separation along the weak basal cleavage in apatite. This is clearly indicated by the common occurrence of only 1 or no clear crystal terminations present on separated apatite grains, and evidence of freshly broken ends when grains are viewed using a scanning electron microscope. This matters because if the 4He distribution within the whole grain is not homogeneous, because of partial loss due to thermal diffusion for example, then the fragments will all yield ages different from each other and from the whole grain age. Here we use a numerical model with a finite cylinder geometry to approximate 4He ingrowth and thermal diffusion within hexagonal prismatic apatite crystals. This is used to quantify the amount and patterns of inherent, natural age dispersion that arises from analysing broken crystals. A series of systematic numerical experiments were conducted to explore and quantify the pattern and behaviour of this source of dispersion using a set of 5 simple thermal histories that represent a range of plausible geological scenarios. In addition some more complex numerical experiments were run to investigate the pattern and behaviour of grain dispersion seen in several real data sets. The results indicate that natural dispersion of a set of single fragment ages (defined as the range divided by the mean) arising from fragmentation alone varies from c. 7% even for rapid (c. 10 °C/Ma), monotonic cooling to over 50% for protracted, complex histories that cause significant diffusional loss of 4He. The magnitude of dispersion arising from fragmentation scales with the grain cylindrical radius, and is of a similar magnitude to dispersion expected from differences in absolute grain size alone (spherical equivalent radii of 40-150 μm). This source of dispersion is significant compared with typical analytical uncertainties on individual grain analyses (c. 6%) and standard deviations on multiple grain analyses from a single sample (c. 10-20%). Where there is a significant difference in the U and Th concentration of individual grains (eU), the effect of radiation damage accumulation on 4He diffusivity (assessed using the RDAAM model of Flowers et al. (2009)) is the primary cause of dispersion for samples that have experienced a protracted thermal history, and can cause dispersion in excess of 100% for realistic ranges of eU concentration (i.e. 5-100 ppm). Expected natural dispersion arising from the combined effects of reasonable variations in grain size (radii 40-125 μm), eU concentration (5-150 ppm) and fragmentation would typically exceed 100% for complex thermal histories. In addition to adding a significant component of natural dispersion to analyses, the effect of fragmentation also acts to decouple and corrupt expected correlations between grain ages and absolute grain size and to a lesser extent between grain age and effective uranium concentration (eU). Considering fragmentation explicitly as a source of dispersion and analysing how the different sources of natural dispersion all interact with each other provides a quantitative framework for understanding patterns of dispersion that otherwise appear chaotic. An important outcome of these numerical experiments is that they demonstrate that the pattern of age dispersion arising from fragmentation mimics the pattern of 4He distribution within the whole grains, thus providing an important source of information about the thermal history of the sample. We suggest that if the primary focus of a study is to extract the thermal history information from (U-Th)/He analyses then sampling and analytical strategies should aim to maximise the natural dispersion of grain ages, not minimise it, and should aim to analyse circa 20-30 grains from each sample. The key observations and conclusions drawn here are directly applicable to other thermochronometers, such as the apatite, rutile and titanite U-Pb systems, where the diffusion domain is approximated by the physical grain size.

Analysis of ligand-protein exchange by Clustering of Ligand Diffusion Coefficient Pairs (CoLD-CoP).

PubMed

Snyder, David A; Chantova, Mihaela; Chaudhry, Saadia

2015-06-01

NMR spectroscopy is a powerful tool in describing protein structures and protein activity for pharmaceutical and biochemical development. This study describes a method to determine weak binding ligands in biological systems by using hierarchic diffusion coefficient clustering of multidimensional data obtained with a 400 MHz Bruker NMR. Comparison of DOSY spectrums of ligands of the chemical library in the presence and absence of target proteins show translational diffusion rates for small molecules upon interaction with macromolecules. For weak binders such as compounds found in fragment libraries, changes in diffusion rates upon macromolecular binding are on the order of the precision of DOSY diffusion measurements, and identifying such subtle shifts in diffusion requires careful statistical analysis. The "CoLD-CoP" (Clustering of Ligand Diffusion Coefficient Pairs) method presented here uses SAHN clustering to identify protein-binders in a chemical library or even a not fully characterized metabolite mixture. We will show how DOSY NMR and the "CoLD-CoP" method complement each other in identifying the most suitable candidates for lysozyme and wheat germ acid phosphatase. Copyright © 2015 Elsevier Inc. All rights reserved.

Calculations on the orientation of the CH fragment in Co 3(CO) 9(μ 3-CH): Implications for metal surfaces

NASA Astrophysics Data System (ADS)

DeKock, Roger L.; Fehlner, Thomas P.

1982-07-01

A series of molecular orbital calculations using the Fenske-Hall method have been carried out on Co 3(CO) 9(μ 3-CH), in which the orientation of the CH fragment is varied with respect to the triangular plane of the three Co atoms. The calculations show that the energy differences between the orbitals that are predominantly CH in character are affected very little by the orientation of the CH fragment. These calculated differences are Δ(2 σ-1 σ)≅7 eV and Δ(1 π-1 σ)≅ 10.5 eV. The calculated splitting of the degenerate 1π orbitals for geometries with tilted CH fragments never amounted to more than 0.46 eV. Mixing of CH orbitals into the predominantly Co 3d manifold was extensive in all of the calculations. These calculations provide no support for the interpretation of energy loss and photoemission electron spectroscopy experiments in terms of CH fragments that are tilted with respect to the metal surface, but such an interpretation cannot be eliminated due to the diffuse nature of the spectral bands in the photoemission experiments.

Llama VHH antibody fragments against GFAP: better diffusion in fixed tissues than classical monoclonal antibodies.

PubMed

Perruchini, Claire; Pecorari, Frederic; Bourgeois, Jean-Pierre; Duyckaerts, Charles; Rougeon, François; Lafaye, Pierre

2009-11-01

Camelids produce antibodies made of homodimeric heavy chains, and the antigen-binding region being composed of a single domain called VHH. These VHHs are much smaller than complete IgG. They are also more thermostable and more soluble in water; they should, therefore, diffuse more readily in the tissues. VHHs, expressed in bacteria, are easier to produce than conventional monoclonal antibodies. Because of these special characteristics, these antibody fragments could have interesting developments in immunohistochemistry and in the development of biomarkers. To test the possibility of their use in immunohistochemistry (IHC), we selected the glial fibrillary acidic protein (GFAP), a well-known marker of astrocytes. One alpaca (Lama pacos) was immunized against GFAP. Lymphocytes were isolated; the DNA was extracted; the VHH-coding sequences were selectively amplified. Three VHHs with a high affinity for GFAP and their corresponding mRNA were selected by ribosome display. Large quantities of the recombinant VHHs coupled with different tags were harvested from transfected bacteria. One of them was shown to immunolabel strongly and specifically to GFAP of human astrocytes in tissue sections. The quality of the IHC was comparable or, in some aspects, superior to the quality obtained with conventional IgG. The VHH was shown to diffuse on a longer distance than conventional monoclonal antibodies in fixed cortical tissue: a property that may be useful in immunolabeling of thick sections.

Canine left ventricle electromechanical behavior under different pacing modes.

PubMed

Vo Thang, Thanh-Thuy; Thibault, Bernard; Finnerty, Vincent; Pelletier-Galarneau, Matthieu; Khairy, Paul; Grégoire, Jean; Harel, François

2012-10-01

Cardiac resynchronization therapy may improve survival and quality of life in patients suffering from heart failure with left ventricular (LV) contraction dyssynchrony. While several studies have investigated electrical or mechanical determinants of synchronous contraction, few have focused on activation contraction coupling at a macroscopic level. The objective of the study was to characterize LV electromechanical behavior and response to pacing in a heart failure model. We analyzed data from 3D electroanatomic non-contact mapping and blood pool SPECT for 12 dogs with right ventricular (RV) tachycardia pacing-induced dilated cardiomyopathy. Surfaces generated by the two modalities were registered. Electrical signals were analyzed, and endocardial wall displacement curves were portrayed. Rapid pacing decreased the mean LV ejection fraction (LVEF) to 20.9 % and prolonged the QRS duration to 79 ± 10 ms (normal range: 40-50 ms). QRS duration remained unchanged with biventricular pacing (88.5 ms), while single site pacing further prolonged the QRS duration (113.3 ms for RV pacing and 111.6 ms for LV pacing). No trend was observed in LV systolic function. Activation duration time was significantly increased with all pacing modes compared to baseline. Finally, electromechanical delay, as defined by the delay between electrical activation and mechanical response, was increased by single site pacing (172.9 ms for RV pacing and 174.6 ms for LV pacing) but not by biventricular pacing (162.4 ms). Combined temporal and spatial coregistration electroanatomic maps and baseline gated blood pool SPECT imaging allowed us to quantify activation duration time, electromechanical delay, and LVEF for different pacing modes. Even if pacing modes did not significantly modify LVEF or activation duration, they produced alterations in electromechanical delay, with biventricular pacing significantly decreasing the electromechanical delay as measured by surface tracings and endocardial non-contact mapping.

Evaluation of clinical and electrocardiographic changes during the euthanasia of horses.

PubMed

Buhl, R; Andersen, L O F; Karlshøj, M; Kanters, J K

2013-06-01

The objective of this prospective field study was to investigate whether commonly used criteria for clinical death occurred at the same time as cardiac death, as determined by electrocardiography. Specific ECG changes during euthanasia were also studied. Twenty-nine horses were euthanized with pentobarbital at two different dose rates and 15 of the 29 horses also received detomidine hydrochloride for sedation. ECG was recorded prior to and during euthanasia. Time to collapse, cessation of reflexes, heart sounds and asystole were recorded. ECG recordings were used to calculate RR intervals, PQ duration, QRS duration, distance from QRS complex to end of T wave corrected for HR (QTc interval), duration of T-wave from peak to end (TpeakTend) and amplitudes of T wave (Tpeak) before and during euthanasia. Differences between groups and ECG changes were evaluated using analysis of variance. Clinical determination of death occurred before cardiac death (P<0.05). Sedated horses took longer to collapse than unsedated horses (P<0.0001), but asystole occurred faster in sedated horses (P<0.0001). No significant changes in QRS duration were observed, but RR, PQ, QTc, TpeakTend and Tpeak were influenced by both pentobarbital dose and sedation (P<0.05-<0.0001). In conclusion, sedation prior to euthanasia resulted in a shorter time to asystole and is therefore recommended for the euthanasia of horses. Importantly, the results show that the clinical definition of death occurred significantly earlier than cardiac death (defined as asystole), which indicates that the clinical declaration of death in horses could be premature compared to that used in humans. Copyright © 2012 Elsevier Ltd. All rights reserved.

Non-selective His bundle pacing with a biphasic waveform: enhancing septal resynchronization.

PubMed

Ortega, Daniel F; Barja, Luis D; Logarzo, Emilio; Mangani, Nicolas; Paolucci, Analia; Bonomini, Maria P

2018-05-01

His bundle pacing has shown to prevent detrimental effects from right ventricular apical pacing (RVA) and proved to resynchronize many conduction disturbances cases. However, the extent of His bundle pacing resynchronization is limited. An optimized stimulation waveform could expand this limit when implemented in His bundle pacing sets. In this work, we temporarily implemented RVA and Non-selective His bundle pacing with a biphasic anodal-first waveform (AF-nHB) and compared their effects against sinus rhythm (SR). Fifteen patients referred for electrophysiologic study with conduction disturbances, cardiomyopathy and ejection fraction below 35% were enrolled for the study. The following acute parameters were measured: QRS duration, left ventricular activation (RLVT), time of isovolumic contraction (IVCT), ejection fraction (EF), and dP/dtmax. QRS duration and RLVT decreased markedly under AF-nHB (SR: 169 ± 34 ms vs. nHB: 116 ± 31 ms, P < 0.0005) while RVA significantly increased QRS duration (SR: 169 ms vs. RVA: 198 ms, P < 0.05) and did not change RLVT (P = NS). Consistently, IVCT moderately decreased under AF-nHB (SR: 238 ms vs. RVA: 184 ms, P < 0.05 vs. SR) and dP/dtmax showed a 93.35 [mmHg] average increase under AF-nHB against SR. Also, T-wave inversions were observed during AF-nHB immediately after SR and RVA pacing suggesting the occurrence of cardiac memory. AF-nHB corrected bundle branch blocks in patients with severe conduction disturbances, even in those with dilated cardiomiopathy, outstanding from RVA. Also, the occurrence of cardiac memory during AF-nHB turned up as an observational finding of this study.

Late deterioration of left ventricular function after right ventricular pacemaker implantation.

PubMed

Bellmann, Barbara; Muntean, Bogdan G; Lin, Tina; Gemein, Christopher; Schmitz, Kathrin; Schauerte, Patrick

2016-09-01

Right ventricular (RV) pacing induces a left bundle branch block pattern on ECG and may promote heart failure. Patients with dual chamber pacemakers (DCPs) who present with progressive reduction in left ventricular ejection fraction (LVEF) secondary to RV pacing are candidates for cardiac resynchronization therapy (CRT). This study analyzes whether upgrading DCP to CRT with the additional implantation of a left ventricular (LV) lead improves LV function in patients with reduced LVEF following DCP implantation. Twenty-two patients (13 males) implanted with DCPs and a high RV pacing percentage (>90%) were evaluated in term of new-onset heart failure symptoms. The patients were enrolled in this retrospective single-center study after obvious causes for a reduced LVEF were excluded with echocardiography and coronary angiography. In all patients, DCPs were then upgraded to biventricular devices. LVEF was analyzed with a two-sided t-test. QRS duration and brain natriuretic peptide (BNP) levels were analyzed with the unpaired t-test. LVEF declined after DCP implantation from 54±10% to 31±7%, and the mean QRS duration was 161±20 ms during RV pacing. NT-pro BNP levels were elevated (3365±11436 pmol/L). After upgrading to a biventricular device, a biventricular pacing percentage of 98.1±2% was achieved. QRS duration decreased to 108±16 ms and 106±20 ms after 1 and 6 months, respectively. There was a significant increase in LVEF to 38±8% and 41±11% and a decrease in NT-pro BNP levels to 3088±2326 pmol/L and 1860±1838 pmol/L at 1 and 6 months, respectively. Upgrading to CRT may be beneficial in patients with DCPs and heart failure induced by a high RV pacing percentage.

New approach for T-wave peak detection and T-wave end location in 12-lead paced ECG signals based on a mathematical model.

PubMed

Madeiro, João P V; Nicolson, William B; Cortez, Paulo C; Marques, João A L; Vázquez-Seisdedos, Carlos R; Elangovan, Narmadha; Ng, G Andre; Schlindwein, Fernando S

2013-08-01

This paper presents an innovative approach for T-wave peak detection and subsequent T-wave end location in 12-lead paced ECG signals based on a mathematical model of a skewed Gaussian function. Following the stage of QRS segmentation, we establish search windows using a number of the earliest intervals between each QRS offset and subsequent QRS onset. Then, we compute a template based on a Gaussian-function, modified by a mathematical procedure to insert asymmetry, which models the T-wave. Cross-correlation and an approach based on the computation of Trapezium's area are used to locate, respectively, the peak and end point of each T-wave throughout the whole raw ECG signal. For evaluating purposes, we used a database of high resolution 12-lead paced ECG signals, recorded from patients with ischaemic cardiomyopathy (ICM) in the University Hospitals of Leicester NHS Trust, UK, and the well-known QT database. The average T-wave detection rates, sensitivity and positive predictivity, were both equal to 99.12%, for the first database, and, respectively, equal to 99.32% and 99.47%, for QT database. The average time errors computed for T-wave peak and T-wave end locations were, respectively, -0.38±7.12 ms and -3.70±15.46 ms, for the first database, and 1.40±8.99 ms and 2.83±15.27 ms, for QT database. The results demonstrate the accuracy, consistency and robustness of the proposed method for a wide variety of T-wave morphologies studied. Copyright © 2012 IPEM. Published by Elsevier Ltd. All rights reserved.

A systematic approach to designing reliable VV optimization methodology: assessment of internal validity of echocardiographic, electrocardiographic and haemodynamic optimization of cardiac resynchronization therapy.

PubMed

Kyriacou, Andreas; Li Kam Wa, Matthew E; Pabari, Punam A; Unsworth, Beth; Baruah, Resham; Willson, Keith; Peters, Nicholas S; Kanagaratnam, Prapa; Hughes, Alun D; Mayet, Jamil; Whinnett, Zachary I; Francis, Darrel P

2013-08-10

In atrial fibrillation (AF), VV optimization of biventricular pacemakers can be examined in isolation. We used this approach to evaluate internal validity of three VV optimization methods by three criteria. Twenty patients (16 men, age 75 ± 7) in AF were optimized, at two paced heart rates, by LVOT VTI (flow), non-invasive arterial pressure, and ECG (minimizing QRS duration). Each optimization method was evaluated for: singularity (unique peak of function), reproducibility of optimum, and biological plausibility of the distribution of optima. The reproducibility (standard deviation of the difference, SDD) of the optimal VV delay was 10 ms for pressure, versus 8 ms (p=ns) for QRS and 34 ms (p<0.01) for flow. Singularity of optimum was 85% for pressure, 63% for ECG and 45% for flow (Chi(2)=10.9, p<0.005). The distribution of pressure optima was biologically plausible, with 80% LV pre-excited (p=0.007). The distributions of ECG (55% LV pre-excitation) and flow (45% LV pre-excitation) optima were no different to random (p=ns). The pressure-derived optimal VV delay is unaffected by the paced rate: SDD between slow and fast heart rate is 9 ms, no different from the reproducibility SDD at both heart rates. Using non-invasive arterial pressure, VV delay optimization by parabolic fitting is achievable with good precision, satisfying all 3 criteria of internal validity. VV optimum is unaffected by heart rate. Neither QRS minimization nor LVOT VTI satisfy all validity criteria, and therefore seem weaker candidate modalities for VV optimization. AF, unlinking interventricular from atrioventricular delay, uniquely exposes resynchronization concepts to experimental scrutiny. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Pulmonary Right Ventricular Resynchronization in Congenital Heart Disease: Acute Improvement in Right Ventricular Mechanics and Contraction Efficiency.

PubMed

Janoušek, Jan; Kovanda, Jan; Ložek, Miroslav; Tomek, Viktor; Vojtovič, Pavel; Gebauer, Roman; Kubuš, Peter; Krejčíř, Miroslav; Lumens, Joost; Delhaas, Tammo; Prinzen, Frits

2017-09-01

Electromechanical discoordination may contribute to long-term pulmonary right ventricular (RV) dysfunction in patients after surgery for congenital heart disease. We sought to evaluate changes in RV function after temporary RV cardiac resynchronization therapy. Twenty-five patients aged median 12.0 years after repair of tetralogy of Fallot and similar lesions were studied echocardiographically (n=23) and by cardiac catheterization (n=5) after primary repair (n=4) or after surgical RV revalvulation for significant pulmonary regurgitation (n=21). Temporary RV cardiac resynchronization therapy was applied in the presence of complete right bundle branch block by atrial-synchronized RV free wall pacing in complete fusion with spontaneous ventricular depolarization using temporary electrodes. The q-RV interval at the RV free wall pacing site (mean 77.2% of baseline QRS duration) confirmed pacing from a late activated RV area. RV cardiac resynchronization therapy carried significant decrease in QRS duration ( P <0.001) along with elimination of the right bundle branch block QRS morphology, increase in RV filling time ( P =0.002), pulmonary artery velocity time integral ( P =0.006), and RV maximum +dP/dt ( P <0.001), and decrease in RV index of myocardial performance ( P =0.006). RV mechanical synchrony improved: septal-to-lateral RV mechanical delay decreased ( P <0.001) and signs of RV dyssynchrony pattern were significantly abolished. RV systolic stretch fraction reflecting the ratio of myocardial stretching and contraction during systole diminished ( P =0.001). In patients with congenital heart disease and right bundle branch block, RV cardiac resynchronization therapy carried multiple positive effects on RV mechanics, synchrony, and contraction efficiency. © 2017 American Heart Association, Inc.

The effect of sport on computerized electrocardiogram measurements in college athletes.

PubMed

Gademan, Maaike G J; Uberoi, Abhimanyu; Le, Vy-Van; Mandic, Sandra; van Oort, Eddy R; Myers, Jonathan; Froelicher, Victor F

2012-02-01

Broad criteria for abnormal electrocardiogram (ECG) findings, requiring additional testing, have been recommended for preparticipation exams (PPE) of athletes. As these criteria have not considered the sport in which athletes participate, we examined the effect of sports on the computerized ECG measurements obtained in college athletes. During the Stanford 2007 PPE, computerized 12-lead ECGs (Schiller AG) were obtained in 641 athletes (350 male/291 female, age 19.5 ± 2 years). Athletes were engaged in 22 different sports and were grouped into 16 categories: baseball/softball, basketball, crew, crosscountry, fencing, field events, football linemen, football other positions, golf, gymnastics, racquet sports, sailing, track/field, volleyball, water sports, and wrestling. The analysis focused on ECG leads V2, aVF and V5 which provide a three-dimensional representation of the heart's electrical activity. As marked ECG differences exist between males and females, the data are presented by gender. In males, ANOVA analysis yielded significant ECG differences between sports for heart rate, QRS duration, QTc, J-amplitude in V2 and V5, spatial vector length (SVL) of the P wave, SVL R wave, and SVL T wave, and RS(sum) (p < 0.05). In females ECG differences between sports were found for heart rate, QRS duration, QRS axis and SVL T wave (p < 0.05). Poor correlations were found between body dimensions and ECG measurements (r < 0.50). Significant ECG changes exist between college athletes participating in different sports, and these differences were more apparent in males than females. Therefore, sport-specific ECG criteria for abnormal ECG findings should be developed to obtain a more useful approach to ECG screening in athletes.

Septal and Anterior Reverse Mismatch of Myocardial Perfusion and Metabolism in Patients With Coronary Artery Disease and Left Bundle Branch Block

PubMed Central

Wang, Jian-Guang; Fang, Wei; Yang, Min-Fu; Tian, Yue-Qin; Zhang, Xiao-Li; Shen, Rui; Sun, Xiao-Xin; Guo, Feng; Wang, Dao-Yu; He, Zuo-Xiang

2015-01-01

Abstract The effects of left bundle branch block (LBBB) on left ventricular myocardial metabolism have not been well investigated. This study evaluated these effects in patients with coronary artery disease (CAD). Sixty-five CAD patients with complete LBBB (mean age, 61.8 ± 9.7 years) and 65 without LBBB (mean age, 59.9 ± 8.4 years) underwent single photon emission computed tomography, positron emission tomography, and contrast coronary angiography. The relationship between myocardial perfusion and metabolism and reverse mismatch score, and that between QRS length and reverse mismatch score and wall motion score were evaluated. The incidence of left ventricular septum and anterior wall reverse mismatching between the two groups was significantly different (P < 0.001 and P = 0.002, respectively). The incidences of normal myocardial perfusion and metabolism in the left ventricular lateral and inferior walls were also significantly different between the two groups (P < 0.001 and P < 0.001, respectively). The incidence of septal reverse mismatching in patients with mild to moderate perfusion was significantly higher among those with LBBB than among those without LBBB (P < 0.001). In CAD patients with LBBB, septal reverse mismatching was significantly more common among those with mild to moderate perfusion than among those with severe perfusion defects (P = 0.002). The correlation between the septal reverse mismatch score and QRS length was significant (P = 0.026). In patients with CAD and LBBB, septal and anterior reverse mismatching of myocardial perfusion and metabolism was frequently present; the septal reverse mismatch score negatively correlated with the QRS interval. PMID:25997045

Accurate derivation of heart rate variability signal for detection of sleep disordered breathing in children.

PubMed

Chatlapalli, S; Nazeran, H; Melarkod, V; Krishnam, R; Estrada, E; Pamula, Y; Cabrera, S

2004-01-01

The electrocardiogram (ECG) signal is used extensively as a low cost diagnostic tool to provide information concerning the heart's state of health. Accurate determination of the QRS complex, in particular, reliable detection of the R wave peak, is essential in computer based ECG analysis. ECG data from Physionet's Sleep-Apnea database were used to develop, test, and validate a robust heart rate variability (HRV) signal derivation algorithm. The HRV signal was derived from pre-processed ECG signals by developing an enhanced Hilbert transform (EHT) algorithm with built-in missing beat detection capability for reliable QRS detection. The performance of the EHT algorithm was then compared against that of a popular Hilbert transform-based (HT) QRS detection algorithm. Autoregressive (AR) modeling of the HRV power spectrum for both EHT- and HT-derived HRV signals was achieved and different parameters from their power spectra as well as approximate entropy were derived for comparison. Poincare plots were then used as a visualization tool to highlight the detection of the missing beats in the EHT method After validation of the EHT algorithm on ECG data from the Physionet, the algorithm was further tested and validated on a dataset obtained from children undergoing polysomnography for detection of sleep disordered breathing (SDB). Sensitive measures of accurate HRV signals were then derived to be used in detecting and diagnosing sleep disordered breathing in children. All signal processing algorithms were implemented in MATLAB. We present a description of the EHT algorithm and analyze pilot data for eight children undergoing nocturnal polysomnography. The pilot data demonstrated that the EHT method provides an accurate way of deriving the HRV signal and plays an important role in extraction of reliable measures to distinguish between periods of normal and sleep disordered breathing (SDB) in children.

Effect of Mobile Phone Radiofrequency Electromagnetic Fields on.

PubMed

Umar, Z U; Abubakar, M B; Ige, J; Igbokwe, U V; Mojiminiyi, F B O; Isezuo, S A

2014-12-29

Since cell phones emit radiofrequency electromagnetic fields (EMFs), this study tested the hypothesis that cell phones placed near the heart may interfere with the electrical rhythm of the heart or affect the blood pressure. Following informed consent, eighteen randomly selected apparently healthy male volunteers aged 21.44 ± 0.53 years had their blood pressure, pulse rates and ECG measured before and after acute exposure to a cell phone. The ECG parameters obtained were: heart rate (HR), QRS complex duration (QRS), PR interval (PR) and Corrected QT interval (QTc). Results are presented as mean ± SEM. Statistical analyses were done using two-tailed paired t test for blood pressure and pulse rate data and one way ANOVA with a post hoc Tukey test for the ECG data. P<0.05 was considered statistically significant. The blood pressure and pulse rates before and after exposure to the cell phone showed no significant difference. The ECG parameters (HR: beats/min, QRS:ms, PR:ms and QTc respectively) did not differ before (66.33 ± 2.50, 91.78 ± 1.36, 151.67 ± 5.39 and 395.44 ± 4.96), during (66.33 ± 2.40, 91.11 ± 1.61, 153.67 ± 5.06 and 394.33 ± 4.05) and after calls (67.22 ± 2.77, 91.11 ± 1.67, 157.44 ± 4.46 and 396.56 ± 4.93) compared to baseline (67.17 ± 2.19, 94.33 ± 1.57, 150.56 ± 4.93 and 399.56 ± 3.88). These results suggest that acute exposure to EMFs from cell phones placed near the heart may not interfere with the electrical activity of the heart or blood pressure in healthy individuals.

Detecting the Elusive P-Wave: A New ECG Lead to Improve the Recording of Atrial Activity.

PubMed

Kennedy, Alan; Finlay, Dewar D; Guldenring, Daniel; Bond, Raymond R; McLaughlin, James

2016-02-01

In this study, we report on a lead selection method that was developed to detect the optimal bipolar electrode placement for recording of the P-wave. The study population consisted of 117 lead body surface potential maps recorded from 229 healthy subjects. The optimal bipolar lead was developed using the training set (172 subjects) then extracted from the testing dataset (57 subjects) and compared to other lead systems previously reported for improved recording of atrial activity. All leads were assessed in terms of P-wave, QRS, and STT root mean square (RMS). The P/QRST RMS ratio was also investigated to determine the atrioventricular RMS ratio. Finally, the effect of minor electrode misplacements on the P-lead was investigated. The P-lead discovered in this study outperformed all other investigated leads in terms of P-wave RMS. The P-lead showed a significant improvement in median P-wave RMS (93 versus 72 μV, p < 0.001) over the next best lead, Lead II. An improvement in QRS and STT RMS was also observed from the P-lead in comparison to lead II (668 versus 573 μV, p < 0.001) and (327 versus 196 μV, p < 0.001). Although P-wave RMS was reduced by incorrect electrode placement, significant improvement over Lead II was still evident. The P-lead improves P-wave RMS signal strength over all other investigated leads. Also the P-lead does not reduce QRS and STT RMS making it an appropriate choice for atrial arrhythmia monitoring. Given the improvement in signal-to-noise ratio, an improvement in algorithms that rely on P-wave analysis may be achieved.

Gender differences in the electrocardiogram screening of athletes.

PubMed

Bessem, Bram B; de Bruijn, Matthijs M C; Nieuwland, Wybe W

2017-02-01

Gender-related differences are frequently used in medicine. Electrocardiograms are also subject to such differences. This study evaluated gender differences in ECG parameters of young athletes, discussing the possible implications of these differences for ECG criteria used in the cardiovascular screening of young athletes. Observational cross-sectional study. In 2013 and 2014 all the ECGs from the cardiovascular screenings performed at University Sports Medical Centre in Groningen of the student athletes who wanted to participate in a college sports program were collected. The ECG characteristics were scored using computer-based measurements and the Seattle ECG criteria. The study population included 1436 athletes, of which 72% were male. Male athletes were older (19.3 years vs. 18.6 years), participated in sports more frequently (4.0/week vs. 3.8/week) and spent more hours per week practising sports (6.4h/week vs. 5.8h/week) than female athletes. Male athletes had significantly higher PR intervals (149ms vs. 141ms), lead voltages and QRS duration (98ms vs. 88ms). Female athletes had significantly higher resting heart rates (69/min vs. 64/min) and QTc intervals (407ms vs. 400ms). Male athletes also had significantly higher amounts of sinus bradycardia (38.3% vs. 23.0%), incomplete RBBB (15.0% vs. 3.7%), early repolarisation (4.5% vs. 1.0%) and isolated QRS voltage criteria for LVH (26.3% vs. 4.6%). All P-values were ≤0.001. ECGs of young athletes demonstrate gender-related differences. These differences could be considered in their cardiovascular screening. For the Seattle ECG criteria we advise additional research into the clinical implications of using gender-based cut-off values for the QRS duration in the intraventricular conduction delay criterion. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Machine Learning Algorithm Predicts Cardiac Resynchronization Therapy Outcomes: Lessons From the COMPANION Trial.

PubMed

Kalscheur, Matthew M; Kipp, Ryan T; Tattersall, Matthew C; Mei, Chaoqun; Buhr, Kevin A; DeMets, David L; Field, Michael E; Eckhardt, Lee L; Page, C David

2018-01-01

Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in heart failure patients with reduced left ventricular function and intraventricular conduction delay. However, individual outcomes vary significantly. This study sought to use a machine learning algorithm to develop a model to predict outcomes after CRT. Models were developed with machine learning algorithms to predict all-cause mortality or heart failure hospitalization at 12 months post-CRT in the COMPANION trial (Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure). The best performing model was developed with the random forest algorithm. The ability of this model to predict all-cause mortality or heart failure hospitalization and all-cause mortality alone was compared with discrimination obtained using a combination of bundle branch block morphology and QRS duration. In the 595 patients with CRT-defibrillator in the COMPANION trial, 105 deaths occurred (median follow-up, 15.7 months). The survival difference across subgroups differentiated by bundle branch block morphology and QRS duration did not reach significance ( P =0.08). The random forest model produced quartiles of patients with an 8-fold difference in survival between those with the highest and lowest predicted probability for events (hazard ratio, 7.96; P <0.0001). The model also discriminated the risk of the composite end point of all-cause mortality or heart failure hospitalization better than subgroups based on bundle branch block morphology and QRS duration. In the COMPANION trial, a machine learning algorithm produced a model that predicted clinical outcomes after CRT. Applied before device implant, this model may better differentiate outcomes over current clinical discriminators and improve shared decision-making with patients. © 2018 American Heart Association, Inc.

Accuracy of ECG indices for diagnosis of left ventricular hypertrophy in people >65 years: results from the ActiFE study.

PubMed

Laszlo, Roman; Kunz, Katia; Dallmeier, Dhayana; Klenk, Jochen; Denkinger, Michael; Koenig, Wolfgang; Rothenbacher, Dietrich; Steinacker, Juergen Michael

2017-10-01

The detection of left ventricular hypertrophy (LVH) is still a common objective of electrocardiography (ECG) in clinical practice. The aim of our study was to evaluate the accuracy of LVH ECG indices in people older than 65 recruited from a population-based cohort (ActiFE-Ulm study). In 432 subjects (mean age 76.2 ± 5.5 years, 51% male), left ventricular mass was echocardiographically determined (Devereux formula) and indexed (LVMI) to body surface area. Several LVH ECG indices (Lewis voltage, Gubner-Ungerleider voltage, Sokolow-Lyon voltage/product, Cornell voltage/product) were calculated with the help of resting ECG data and compared with the echocardiographic assessment. Despite echocardiographic signs of LVH [LVMI > 115 (♂) or >95 g/m 2 (♀)] in 47.5% of all subjects, diagnostic performance of all ECG indices was generally low. Magnitude of all LVH-indices was mainly predicted by frontal QRS axis in multivariate linear regression analysis. In comparison with the literature data from younger subjects, average frontal QRS axis turned counterclockwise. Most probably, age-related counterclockwise turn of frontal QRS axis is mainly explanatory for the decreased magnitude of LVH ECG indices and consecutive worse diagnostic performance of these indices in the elderly. ECG indices for detection of LVH have insufficient predictive values in geriatric subjects and should therefore not be used clinically for this purpose. Nevertheless, due to its established relevancy in cardiac risk stratification in this age group, usage of some established ECG indices might keep its significance even in the age of modern cardiac imaging.

Photoenhanced Attachment for Optical Control of Diffuse Discharges.

DTIC Science & Technology

1987-12-31

17 14 . MONTORING AGNC 14AM & OdRSSii I h e en Controlling Office) IS. SECURITY CLASS. (at Chi* report) Unclassified 15m. OECL ASSI F1CATION... 14 References................................................... 15 Publications................................................. 16...substantial translational energy of the fragments. *: This disposition of energy has important consequences in the 14 4 I . * photochemistry and

Density-dependent liquid nitromethane decomposition: molecular dynamics simulations based on ReaxFF.

PubMed

Rom, Naomi; Zybin, Sergey V; van Duin, Adri C T; Goddard, William A; Zeiri, Yehuda; Katz, Gil; Kosloff, Ronnie

2011-09-15

The decomposition mechanism of hot liquid nitromethane at various compressions was studied using reactive force field (ReaxFF) molecular dynamics simulations. A competition between two different initial thermal decomposition schemes is observed, depending on compression. At low densities, unimolecular C-N bond cleavage is the dominant route, producing CH(3) and NO(2) fragments. As density and pressure rise approaching the Chapman-Jouget detonation conditions (∼30% compression, >2500 K) the dominant mechanism switches to the formation of the CH(3)NO fragment via H-transfer and/or N-O bond rupture. The change in the decomposition mechanism of hot liquid NM leads to a different kinetic and energetic behavior, as well as products distribution. The calculated density dependence of the enthalpy change correlates with the change in initial decomposition reaction mechanism. It can be used as a convenient and useful global parameter for the detection of reaction dynamics. Atomic averaged local diffusion coefficients are shown to be sensitive to the reactions dynamics, and can be used to distinguish between time periods where chemical reactions occur and diffusion-dominated, nonreactive time periods. © 2011 American Chemical Society

Impact of oxygen on the coexistence of nitrification, denitrification, and sulfate reduction in oxygen-based membrane aerated biofilm.

PubMed

Liu, Hong; Tan, Shuying; Sheng, Zhiya; Yu, Tong; Liu, Yang

2015-03-01

Membrane aerated biofilms (MABs) are subject to "counter diffusion" of oxygen and substrates. In a membrane aerated biofilm reactor, gases (e.g., oxygen) diffuse through the membrane into the MAB, and liquid substrates pass from the bulk liquid into the MAB. This behavior can result in a unique biofilm structure in terms of microbial composition, distribution, and community activity in the MAB. Previous studies have shown simultaneous aerobic oxidation, nitrification, and denitrification within a single MAB. Using molecular techniques, we investigated the growth of sulfate-reducing bacteria (SRB) in the oxygen-based MAB attached to a flat sheet membrane. Denaturing gradient gel electrophoresis of the amplified 16S rRNA gene fragments and functional gene fragments specific for ammonia-oxidizing bacteria (amoA), denitrifying bacteria (nirK), and SRB (dsrB) demonstrated the coexistence of nitrifiers, denitrifiers, and SRB communities within a single MAB. The functional diversities of SRB and denitrifiers decreased with an increase in the oxygen concentration in the bulk water of the reactor.

Cardiopulmonary involvement in Fabry's disease.

PubMed

Koskenvuo, Juha W; Kantola, Ilkka M; Nuutila, Pirjo; Knuuti, Juhani; Parkkola, Riitta; Mononen, Ilkka; Hurme, Saija; Kalliokoski, Riikka; Viikari, Jorma S; Wendelin-Saarenhovi, Maria; Kiviniemi, Tuomas O; Hartiala, Jaakko J

2010-04-01

Fabry's disease is an X-linked lysosomal storage disease caused by deficiency of alpha-galactosidase A enzyme activity. Decreased enzyme activity leads to accumulation of glycosphingolipid in different tissues, including endothelial and smooth-muscle cells and cardiomyocytes. There is controversial data on cardiopulmonary involvement in Fabry's disease, because many reports are based on small and selected populations with Fabry's disease. Furthermore, the aetiology of cardiopulmonary symptoms in Fabry's disease is poorly understood. We studied cardiopulmonary involvement in seventeen patients with Fabry's disease (20-65 years, 6 men) using ECG, bicycle stress, cardiac magnetic resonance imaging, spirometry, diffusing capacity and pulmonary high-resolution computed tomography (HRCT) tests. Cardiopulmonary symptoms were compared to observed parameters in cardiopulmonary tests. Left ventricular hypertrophy (LVH) and reduced exercise capacity are the most apparent cardiac changes in both genders with Fabry's disease. ECG parameters were normal when excluding changes related to LVH. Spirometry showed mild reduction in vital capacity and forced expiratory volume in one second (FEV I), and mean values in diffusing capacity tests were within normal limits. Generally, only slight morphological pulmonary changes were detected using pulmonary HRCT, and they were not associated with changes in pulmonary function. The self-reported amount of pulmonary symptoms associated only with lower ejection fraction (P < 0.001) and longer QRS-duration (P = 0.04) of all measured cardiopulmonary parameters, whereas cardiac symptoms have no statistically significant association with any of these parameters. LVH and reduced exercise capacity are the most apparent cardiopulmonary changes in Fabry's disease but they have only a minor association to cardiopulmonary symptoms.Therefore, routine cardiopulmonary evaluation in Fabry's disease using echocardiography is maybe enough when integrated to counselling for aerobic exercise training.

[Shock shape representation of sinus heart rate based on cloud model].

PubMed

Yin, Wenfeng; Zhao, Jie; Chen, Tiantian; Zhang, Junjian; Zhang, Chunyou; Li, Dapeng; An, Baijing

2014-04-01

The present paper is to analyze the trend of sinus heart rate RR interphase sequence after a single ventricular premature beat and to compare it with the two parameters, turbulence onset (TO) and turbulence slope (TS). Based on the acquisition of sinus rhythm concussion sample, we in this paper use a piecewise linearization method to extract its linear characteristics, following which we describe shock form with natural language through cloud model. In the process of acquisition, we use the exponential smoothing method to forecast the position where QRS wave may appear to assist QRS wave detection, and use template to judge whether current cardiac is sinus rhythm. And we choose some signals from MIT-BIH Arrhythmia Database to detect whether the algorithm is effective in Matlab. The results show that our method can correctly detect the changing trend of sinus heart rate. The proposed method can achieve real-time detection of sinus rhythm shocks, which is simple and easily implemented, so that it is effective as a supplementary method.

Cardiac pacemaker battery discharge after external electrical cardioversion for broad QRS Complex Tachycardia.

PubMed

Annamaria, Martino; Andrea, Scapigliati; Michela, Casella; Tommaso, Sanna; Gemma, Pelargonio; Antonio, Dello Russo; Roberto, Zamparelli; Stefano, De Paulis; Fulvio, Bellocci; Rocco, Schiavello

2008-08-01

External electrical cardioversion or defibrillation may be necessary in patients with implanted cardiac pacemaker (PM) or implantable cardioverter defibrillator (ICD). Sudden discharge of high electrical energy employed in direct current (DC) transthoracic countershock may damage the PM/ICD system resulting in a series of possible device malfunctions. For this reason, when defibrillation or cardioversion must be attempted in a patient with a PM or ICD, some precautions should be taken, particularly in PM dependent patients, in order to prevent damage to the device. We report the case of a 76-year-old woman with a dual chamber PM implanted in the right subclavicular region, who received two consecutive transthoracic DC shocks to treat haemodynamically unstable broad QRS complex tachycardia after cardiac surgery performed with a standard sternotomic approach. Because of the sternal wound and thoracic drainage tubes together with the severe clinical compromise, the anterior paddle was positioned near the pulse generator. At the following PM test, a complete battery discharge was detected.

Human Age Recognition by Electrocardiogram Signal Based on Artificial Neural Network

NASA Astrophysics Data System (ADS)

Dasgupta, Hirak

2016-12-01

The objective of this work is to make a neural network function approximation model to detect human age from the electrocardiogram (ECG) signal. The input vectors of the neural network are the Katz fractal dimension of the ECG signal, frequencies in the QRS complex, male or female (represented by numeric constant) and the average of successive R-R peak distance of a particular ECG signal. The QRS complex has been detected by short time Fourier transform algorithm. The successive R peak has been detected by, first cutting the signal into periods by auto-correlation method and then finding the absolute of the highest point in each period. The neural network used in this problem consists of two layers, with Sigmoid neuron in the input and linear neuron in the output layer. The result shows the mean of errors as -0.49, 1.03, 0.79 years and the standard deviation of errors as 1.81, 1.77, 2.70 years during training, cross validation and testing with unknown data sets, respectively.

Self-organized mechano-chemical dynamics in amoeboid locomotion of Physarum fragments

NASA Astrophysics Data System (ADS)

Zhang, Shun; Guy, Robert D.; Lasheras, Juan C.; del Álamo, Juan C.

2017-05-01

The aim of this work is to quantify the spatio-temporal dynamics of flow-driven amoeboid locomotion in small (∼100 μm) fragments of the true slime mold Physarum polycephalum. In this model organism, cellular contraction drives intracellular flows, and these flows transport the chemical signals that regulate contraction in the first place. As a consequence of these non-linear interactions, a diversity of migratory behaviors can be observed in migrating Physarum fragments. To study these dynamics, we measure the spatio-temporal distributions of the velocities of the endoplasm and ectoplasm of each migrating fragment, the traction stresses it generates on the substratum, and the concentration of free intracellular calcium. Using these unprecedented experimental data, we classify migrating Physarum fragments according to their dynamics, finding that they often exhibit spontaneously coordinated waves of flow, contractility and chemical signaling. We show that Physarum fragments exhibiting symmetric spatio-temporal patterns of endoplasmic flow migrate significantly slower than fragments with asymmetric patterns. In addition, our joint measurements of ectoplasm velocity and traction stress at the substratum suggest that forward motion of the ectoplasm is enabled by a succession of stick-slip transitions, which we conjecture are also organized in the form of waves. Combining our experiments with a simplified convection-diffusion model, we show that the convective transport of calcium ions may be key for establishing and maintaining the spatio-temporal patterns of calcium concentration that regulate the generation of contractile forces.

Pulsewidth-dependent nature of laser-induced DNA damage in RPE cells

NASA Astrophysics Data System (ADS)

Hall, Rebecca M.; Glickman, Randolph D.; Rockwell, Benjamin A.; Kumar, Neeru; Noojin, Gary D.

2001-07-01

Ultrashort pulse laser radiation may produce cellular damage through unique mechanisms. Primary cultures of bovine retinal pigment epithelial (RPE) cells were exposed to the out put of a Ti:Sapphire laser producing 30 fs (mode-locked) pulses, 44 amplified fs pulses, or continuous wave exposures at 800 nm. Laser exposures at and below the damage threshold were studied. DNA damage was detected using single cell gel electrophoresis (comet assay). Unexposed (control) cells produced short tails with low tail moments. In contrast, all laser-exposed cells showed some degree of DNA fragmentation, but the size and shape of the resulting comets differed among the various modalities. CW-exposed cells produced generally light and relatively compact tails, suggesting fewer and larger DNA fragments, while mode-locked laser exposures (30 fs pulses) resulted in large and diffuse comets, indicating the DNA was fragmented into many very small pieces. Work is continuing to define the relationship of laser pulsewidth and intensity with the degree of DNA fragmentation. These results suggest that DNA damage may result from multiple mechanisms of laser-cell interaction, including multiphoton absorption.

Hyperthermal (1-100 eV) nitrogen ion scattering damage to D-ribose and 2-deoxy-D-ribose films.

PubMed

Deng, Zongwu; Bald, Ilko; Illenberger, Eugen; Huels, Michael A

2007-10-14

Highly charged heavy ion traversal of a biological medium can produce energetic secondary fragment ions. These fragment ions can in turn cause collisional and reactive scattering damage to DNA. Here we report hyperthermal (1-100 eV) scattering of one such fragment ion (N(+)) from biologically relevant sugar molecules D-ribose and 2-deoxy-D-ribose condensed on polycrystalline Pt substrate. The results indicate that N(+) ion scattering at kinetic energies down to 10 eV induces effective decomposition of both sugar molecules and leads to the desorption of abundant cation and anion fragments. Use of isotope-labeled molecules (5-(13)C D-ribose and 1-D D-ribose) partly reveals some site specificity of the fragment origin. Several scattering reactions are also observed. Both ionic and neutral nitrogen atoms abstract carbon from the molecules to form CN(-) anion at energies down to approximately 5 eV. N(+) ions also abstract hydrogen from hydroxyl groups of the molecules to form NH(-) and NH(2) (-) anions. A fraction of OO(-) fragments abstract hydrogen to form OH(-). The formation of H(3)O(+) ions also involves hydrogen abstraction as well as intramolecular proton transfer. These findings suggest a variety of severe damaging pathways to DNA molecules which occur on the picosecond time scale following heavy ion irradiation of a cell, and prior to the late diffusion-limited homogeneous chemical processes.

Water diffusion in silicate glasses: the effect of glass structure

NASA Astrophysics Data System (ADS)

Kuroda, M.; Tachibana, S.

2016-12-01

Water diffusion in silicate melts (glasses) is one of the main controlling factors of magmatism in a volcanic system. Water diffusivity in silicate glasses depends on its own concentration. However, the mechanism causing those dependences has not been fully understood yet. In order to construct a general model for water diffusion in various silicate glasses, we performed water diffusion experiments in silica glass and proposed a new water diffusion model [Kuroda et al., 2015]. In the model, water diffusivity is controlled by the concentration of both main diffusion species (i.e. molecular water) and diffusion pathways, which are determined by the concentrations of hydroxyl groups and network modifier cations. The model well explains the water diffusivity in various silicate glasses from silica glass to basalt glass. However, pre-exponential factors of water diffusivity in various glasses show five orders of magnitude variations although the pre-exponential factor should ideally represent the jump frequency and the jump distance of molecular water and show a much smaller variation. Here, we attribute the large variation of pre-exponential factors to a glass structure dependence of activation energy for molecular water diffusion. It has been known that the activation energy depends on the water concentration [Nowak and Behrens, 1997]. The concentration of hydroxyls, which cut Si-O-Si network in the glass structure, increases with water concentration, resulting in lowering the activation energy for water diffusion probably due to more fragmented structure. Network modifier cations are likely to play the same role as water. With taking the effect of glass structure into account, we found that the variation of pre-exponential factors of water diffusivity in silicate glasses can be much smaller than the five orders of magnitude, implying that the diffusion of molecular water in silicate glasses is controlled by the same atomic process.

Modeling emerald ash borer dispersal using percolation theory: estimating the rate of range expansion in a fragmented landscape

Treesearch

Robin A. J. Taylor; Daniel A. Herms; Louis R. Iverson

2008-01-01

The dispersal of organisms is rarely random, although diffusion processes can be useful models for movement in approximately homogeneous environments. However, the environments through which all organisms disperse are far from uniform at all scales. The emerald ash borer (EAB), Agrilus planipennis, is obligate on ash (Fraxinus spp...

Levitronix bilateral ventricular assist device, a bridge to recovery in a patient with acute fulminant myocarditis and concomitant cerebellar infarction.

PubMed

Huang, Yi-Fan; Hsu, Po-Shun; Tsai, Chien-Sung; Tsai, Yi-Ting; Lin, Chih-Yuan; Ke, Hong-Yan; Lin, Yi-Chang; Yang, Hsiang-Yu

2018-02-07

We report on the case of a 27-year-old male who presented to our emergency room with chest tightness, dyspnoea and cold sweats. The 12-lead electrocardiogram showed diffuse ventricular tachycardia with wide QRS complexes. Troponin-I level was elevated to 100 ng/ml. The coronary angiogram showed good patency of all three coronary vessels, and acute fulminant myocarditis was suspected. The patient underwent cardiopulmonary resuscitation in the catheter room and high-dose inotropic support was initiated to stabilise his haemodynamic status. After resuscitation, the patient was in a coma and acute stroke was highly suspected. In addition, deteriorating cardiogenic shock with acute renal failure and pulmonary oedema were also detected. Due to haemodynamic compromise despite high-dose inotropic support, a Levitronix ® bilateral ventricular assist device (Bi-VAD) was implanted on an emergency basis for circulatory support. Postoperative brain computed tomography revealed acute left cerebellar infarction. Because the patient had left cerebellar infarction with right hemiplegia, heart transplantation was contraindicated. Eventually, cardiac systolic function recovered well and the patient underwent successful Bi-VAD removal after a total of 18 days on Levitronix ® haemodynamic support. He was weaned from the ventilator two weeks later and was discharged 10 days later.

Electron distribution function in a plasma generated by fission fragments

NASA Technical Reports Server (NTRS)

Hassan, H. A.; Deese, J. E.

1976-01-01

A Boltzmann equation formulation is presented for the determination of the electron distribution function in a plasma generated by fission fragments. The formulation takes into consideration ambipolar diffusion, elastic and inelastic collisions, recombination and ionization, and allows for the fact that the primary electrons are not monoenergetic. Calculations for He in a tube coated with fissionable material shows that, over a wide pressure and neutron flux range, the distribution function is non-Maxwellian, but the electrons are essentially thermal. Moreover, about a third of the energy of the primary electrons is transferred into the inelastic levels of He. This fraction of energy transfer is almost independent of pressure and neutron flux.

Determine the permeability of an amorphous mixture of polydimethylsiloxane and dealuminated zeolite ZSM-5 to various ethanol-water solutions using molecular simulations.

EPA Science Inventory

An amorphous mixture of PDMS and multi-cellular fragments of ZSM-5 is brought together to approximate the properties of a mixed matrix membrane of PDMS with ZSM-5. The permeability coefficient of the amorphous mixture for pure water is the product of the diffusion coefficient of...

The mechanisms of fine particle generation and electrification during Mount St. Helens volcanic eruption

NASA Technical Reports Server (NTRS)

Cheng, R. J.

1982-01-01

Microscopical investigation of volcanic ash collected from ground stations during Mount St. Helens eruptions reveal a distinctive bimodel size distribution with high concentrations of particle ranges at (1) 200-100 microns and (2) 20-0.1 microns. Close examination of individual particles shows that most larger ones are solidified magma particles of porous pumice with numerous gas bubbles in the interior and the smaller ones are all glassy fragments without any detectable gas bubbles. Elemental analysis demonstrates that the fine fragments all have a composition similar to that of the larger pumice particles. Laboratory experiments suggest that the formation of the fine fragments is by bursting of glassy bubbles from a partially solidified surface of a crystallizing molten magma particle. The production of gas bubbles is due to the release of absorbed gases in molten magma particles when solubility decreases during phase transition. Diffusion cloud chamber experiments strongly indicate that sub-micron volcanic fragments are highly hygroscopic and extremely active as cloud condensation nuclei. Ice crystals also are evidently formed on those fragments in a supercooled (-20 C) cloud chamber. It has been reported that charge generation from ocean volcanic eruptions is due to contact of molten lava with sea water. This seems to be insufficient to explain the observed rapid and intense lightning activities over Mount St. Helens eruptions. Therefore, a hypothesis is presented here that highly electrically charged fine solid fragments are ejected by bursting of gas bubbles from the surface of a crystallizing molten magma particles.

12. Photocopy of architectural drawing (from National Archives Architectural and ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

12. Photocopy of architectural drawing (from National Archives Architectural and Cartographic Branch, Alexandria, Va.) 'Non-Com-Officers Qrs.' Quartermaster Generals Office Standard Plan 82, sheet 2, April 1893. Lithograph on linen architectural drawing. DETAILS - Fort Myer, Non-Commissioned Officers Quarters, Washington Avenue between Johnson Lane & Custer Road, Arlington, Arlington County, VA

Quality Rating Systems--The Experiences of Center Directors

ERIC Educational Resources Information Center

Friedman, Dana E.

2007-01-01

Quality Rating System (QRS) initiatives define levels of quality based on research and then support providers with funding and technical assistance to increase their quality. Each program is assessed and given a number of "stars" to indicate to parents what level of quality the program has reached. In this article, the author describes…

Aging modulates dispersion of ventricular repolarization in the very old of the geriatric population.

PubMed

Huang, Jen-Hung; Lin, Ying-Qin; Pan, Nan-Hung; Chen, Yi-Jen

2010-11-01

Aging plays an essential role in cardiac pathophysiology. Knowledge on the ventricular repolarization in very old individuals is limited. An increase of QT dispersion is associated with higher cardiovascular mortality. The purpose of this study is to investigate whether aging changes the QT dispersion in the very old. Heart rate, P wave duration, PR interval, QRS axis, QRS duration, QT interval, and QTc interval were measured from 12-lead resting ECG. QT dispersion (46 ± 21, 47 ± 17, 69 ± 31 ms, p < 0.005) was significantly increased in the age group ≧85 years (n = 29, 89 ± 4 years) than in the age group 75-84 years (n = 33, 79 ± 3 years) and the age group 65-74 years (n = 32, 68 ± 3 years). Aging modulates dispersion of ventricular repolarization, which may contribute to the cardiac mortality in the very old Asian population.

Electrocardiographic features of sudden unexpected death in epilepsy.

PubMed

Chyou, Janice Y; Friedman, Daniel; Cerrone, Marina; Slater, William; Guo, Yu; Taupin, Daniel; O'Rourke, Sean; Priori, Silvia G; Devinsky, Orrin

2016-07-01

Sudden unexpected death in epilepsy (SUDEP) is the most common cause of epilepsy-related mortality. We hypothesized that electrocardiography (ECG) features may distinguish SUDEP cases from living subjects with epilepsy. Using a matched case-control design, we compared ECG studies of 12 consecutive cases of SUDEP over 10 years and 22 epilepsy controls matched for age, sex, epilepsy type (focal, generalized, or unknown/mixed type), concomitant antiepileptic, and psychotropic drug classes. Conduction intervals and prevalence of abnormal ventricular conduction diagnosis (QRS ≥110 msec), abnormal ventricular conduction pattern (QRS <110 msec, morphology of incomplete right or left bundle branch block or intraventricular conduction delay), early repolarization, and features of inherited cardiac channelopathies were assessed. Abnormal ventricular conduction diagnosis and pattern distinguished SUDEP cases from matched controls. Abnormal ventricular conduction diagnosis was present in two cases and no controls. Abnormal ventricular conduction pattern was more common in cases than controls (58% vs. 18%, p = 0.04). Early repolarization was similarly prevalent in cases and controls, but the overall prevalence exceeded that of published community-based cohorts. Wiley Periodicals, Inc. © 2016 International League Against Epilepsy.

Fluorescent Nanocrystals Reveal Regulated Portals of Entry into and Between the Cells of Hydra

PubMed Central

Tortiglione, Claudia; Quarta, Alessandra; Malvindi, Maria Ada; Tino, Angela; Pellegrino, Teresa

2009-01-01

Initially viewed as innovative carriers for biomedical applications, with unique photophysical properties and great versatility to be decorated at their surface with suitable molecules, nanoparticles can also play active roles in mediating biological effects, suggesting the need to deeply investigate the mechanisms underlying cell-nanoparticle interaction and to identify the molecular players. Here we show that the cell uptake of fluorescent CdSe/CdS quantum rods (QRs) by Hydra vulgaris, a simple model organism at the base of metazoan evolution, can be tuned by modifying nanoparticle surface charge. At acidic pH, amino-PEG coated QRs, showing positive surface charge, are actively internalized by tentacle and body ectodermal cells, while negatively charged nanoparticles are not uptaken. In order to identify the molecular factors underlying QR uptake at acidic pH, we provide functional evidence of annexins involvement and explain the QR uptake as the combined result of QR positive charge and annexin membrane insertion. Moreover, tracking QR labelled cells during development and regeneration allowed us to uncover novel intercellular trafficking and cell dynamics underlying the remarkable plasticity of this ancient organism. PMID:19888325

Device therapy in heart failure with reduced ejection fraction-cardiac resynchronization therapy and more.

PubMed

Duncker, D; Veltmann, C

2018-05-09

In patients with heart failure with reduced ejection fraction (HFrEF), optimal medical treatment includes beta-blockers, ACE inhibitors/angiotensinreceptor-neprilysin inhibitors (ARNI), mineralocorticoid receptor antagonists, and ivabradine when indicated. In device therapy of HFrEF, implantable cardioverter-defibrillators and cardiac resynchronization therapy (CRT) have been established for many years. CRT is the therapy of choice (class I indication) in symptomatic patients with HFrEF and a broad QRS complex with a left bundle branch block (LBBB) morphology. However, the vast majority of heart failure patients show a narrow QRS complex or a non-LBBB morphology. These patients are not candidates for CRT and alternative electrical therapies such as baroreflex activation therapy (BAT) and cardiac contractility modulation (CCM) may be considered. BAT modulates vegetative dysregulation in heart failure. CCM improves contractility, functional capacity, and symptoms. Although a broad data set is available for BAT and CCM, mortality data are still lacking for both methods. This article provides an overview of the device-based therapeutic options for patients with HFrEF.

Wireless Sensor-Based Smart-Clothing Platform for ECG Monitoring

PubMed Central

Lin, Chung-Chih; Yu, Yan-Shuo

2015-01-01

The goal of this study is to use wireless sensor technologies to develop a smart clothes service platform for health monitoring. Our platform consists of smart clothes, a sensor node, a gateway server, and a health cloud. The smart clothes have fabric electrodes to detect electrocardiography (ECG) signals. The sensor node improves the accuracy of QRS complexes detection by morphology analysis and reduces power consumption by the power-saving transmission functionality. The gateway server provides a reconfigurable finite state machine (RFSM) software architecture for abnormal ECG detection to support online updating. Most normal ECG can be filtered out, and the abnormal ECG is further analyzed in the health cloud. Three experiments are conducted to evaluate the platform's performance. The results demonstrate that the signal-to-noise ratio (SNR) of the smart clothes exceeds 37 dB, which is within the “very good signal” interval. The average of the QRS sensitivity and positive prediction is above 99.5%. Power-saving transmission is reduced by nearly 1980 times the power consumption in the best-case analysis. PMID:26640512

Wireless Sensor-Based Smart-Clothing Platform for ECG Monitoring.

PubMed

Wang, Jie; Lin, Chung-Chih; Yu, Yan-Shuo; Yu, Tsang-Chu

2015-01-01

The goal of this study is to use wireless sensor technologies to develop a smart clothes service platform for health monitoring. Our platform consists of smart clothes, a sensor node, a gateway server, and a health cloud. The smart clothes have fabric electrodes to detect electrocardiography (ECG) signals. The sensor node improves the accuracy of QRS complexes detection by morphology analysis and reduces power consumption by the power-saving transmission functionality. The gateway server provides a reconfigurable finite state machine (RFSM) software architecture for abnormal ECG detection to support online updating. Most normal ECG can be filtered out, and the abnormal ECG is further analyzed in the health cloud. Three experiments are conducted to evaluate the platform's performance. The results demonstrate that the signal-to-noise ratio (SNR) of the smart clothes exceeds 37 dB, which is within the "very good signal" interval. The average of the QRS sensitivity and positive prediction is above 99.5%. Power-saving transmission is reduced by nearly 1980 times the power consumption in the best-case analysis.

Quantification of the first-order high-pass filter's influence on the automatic measurements of the electrocardiogram.

PubMed

Isaksen, Jonas; Leber, Remo; Schmid, Ramun; Schmid, Hans-Jakob; Generali, Gianluca; Abächerli, Roger

2017-02-01

The first-order high-pass filter (AC coupling) has previously been shown to affect the ECG for higher cut-off frequencies. We seek to find a systematic deviation in computer measurements of the electrocardiogram when the AC coupling with a 0.05 Hz first-order high-pass filter is used. The standard 12-lead electrocardiogram from 1248 patients and the automated measurements of their DC and AC coupled version were used. We expect a large unipolar QRS-complex to produce a deviation in the opposite direction in the ST-segment. We found a strong correlation between the QRS integral and the offset throughout the ST-segment. The coefficient for J amplitude deviation was found to be -0.277 µV/(µV⋅s). Potential dangerous alterations to the diagnostically important ST-segment were found. Medical professionals and software developers for electrocardiogram interpretation programs should be aware of such high-pass filter effects since they could be misinterpreted as pathophysiology or some pathophysiology could be masked by these effects. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

A modular projection autostereoscopic system for stereo cinema

NASA Astrophysics Data System (ADS)

Elkhov, Victor A.; Kondratiev, Nikolai V.; Ovechkis, Yuri N.; Pautova, Larisa V.

2009-02-01

The lenticular raster system for 3D movies non-glasses show designed by NIKFI demonstrated commercially in Moscow in the 40'st of the last century. Essential lack of this method was narrow individual viewing zone as only two images on the film used. To solve this problem, we propose to use digital video projective system with modular principle of its design. Increase of the general number of the pixels forming the stereo image is reached by using of more than one projector. The modular projection autostereoscopic system for demonstration of the 3D movies includes diffuser screen; lenticular plate located in front of the screen; projective system consisted from several projectors and the block of parallax panoramogram fragments creator. By means of this block the parallax panoramogram is broken into fragments which quantity corresponds to number of projectors. For the large dimension lenticular screen making rectangular fragments of inclined raster were joined in a uniform leaf. To obtain the needed focal distance of the screen lenses we used immersion - aqueous solution of glycerin. The immersion also let essentially decrease visibility of fragments joints. An experimental prototype of the modular projection autostereoscopic system was created to validate proposed system.

New insights on the Dronino iron meteorite by double-pulse micro-Laser-Induced Breakdown Spectroscopy

NASA Astrophysics Data System (ADS)

Tempesta, Gioacchino; Senesi, Giorgio S.; Manzari, Paola; Agrosì, Giovanna

2018-06-01

Two fragments of an iron meteorite shower named Dronino were characterized by a novel technique, i.e. Double-Pulse micro-Laser Induced Breakdown Spectroscopy (DP-μLIBS) combined with optical microscope. This technique allowed to perform a fast and detailed analysis of the chemical composition of the fragments and permitted to determine their composition, the alteration state differences and the cooling rate of the meteorite. Qualitative analysis indicated the presence of Fe, Ni and Co in both fragments, whereas the elements Al, Ca, Mg, Si and, for the first time Li, were detected only in one fragment and were related to its post-falling alteration and contamination by weathering processes. Quantitative analysis data obtained using the calibration-free (CF) - LIBS method showed a good agreement with those obtained by traditional methods generally applied to meteorite analysis, i.e. Electron Dispersion Spectroscopy - Scanning Electron Microscopy (EDS-SEM), also performed in this study, and Electron Probe Microanalysis (EMPA) (literature data). The local and coupled variability of Ni and Co (increase of Ni and decrease of Co) determined for the unaltered portions exhibiting plessite texture, suggested the occurrence of solid state diffusion processes under a slow cooling rate for the Dronino meteorite.

Best dispersal strategies in spatially heterogeneous environments: optimization of the principal eigenvalue for indefinite fractional Neumann problems.

PubMed

Pellacci, Benedetta; Verzini, Gianmaria

2018-05-01

We study the positive principal eigenvalue of a weighted problem associated with the Neumann spectral fractional Laplacian. This analysis is related to the investigation of the survival threshold in population dynamics. Our main result concerns the optimization of such threshold with respect to the fractional order [Formula: see text], the case [Formula: see text] corresponding to the standard Neumann Laplacian: when the habitat is not too fragmented, the principal positive eigenvalue can not have local minima for [Formula: see text]. As a consequence, the best strategy for survival is either following the diffusion with [Formula: see text] (i.e. Brownian diffusion), or with the lowest possible s (i.e. diffusion allowing long jumps), depending on the size of the domain. In addition, we show that analogous results hold for the standard fractional Laplacian in [Formula: see text], in periodic environments.

Drift-wave turbulence and zonal flow generation.

PubMed

Balescu, R

2003-10-01

Drift-wave turbulence in a plasma is analyzed on the basis of the wave Liouville equation, describing the evolution of the distribution function of wave packets (quasiparticles) characterized by position x and wave vector k. A closed kinetic equation is derived for the ensemble-averaged part of this function by the methods of nonequilibrium statistical mechanics. It has the form of a non-Markovian advection-diffusion equation describing coupled diffusion processes in x and k spaces. General forms of the diffusion coefficients are obtained in terms of Lagrangian velocity correlations. The latter are calculated in the decorrelation trajectory approximation, a method recently developed for an accurate measure of the important trapping phenomena of particles in the rugged electrostatic potential. The analysis of individual decorrelation trajectories provides an illustration of the fragmentation of drift-wave structures in the radial direction and the generation of long-wavelength structures in the poloidal direction that are identified as zonal flows.

B-type natriuretic peptide as a predictor of ischemia/reperfusion injury immediately after myocardial reperfusion in patients with ST-segment elevation acute myocardial infarction.

PubMed

Arakawa, Kentaro; Himeno, Hideo; Kirigaya, Jin; Otomo, Fumie; Matsushita, Kensuke; Nakahashi, Hidefumi; Shimizu, Satoru; Nitta, Manabu; Takamizawa, Tetsu; Yano, Hideto; Endo, Mitsuaki; Kanna, Masahiko; Kimura, Kazuo; Umemura, Satoshi

2016-02-01

In animal models of acute myocardial infarction (AMI), B-type natriuretic peptide (BNP) administered before and during coronary occlusion limits infarct size. However, the relation between plasma BNP levels and ischemia/reperfusion injury remains unclear. 302 patients with ST-segment elevation AMI (STEMI) received emergency percutaneous coronary intervention within six hours from the onset. The patients were divided into two groups according to the plasma BNP level before angiography: group L (n=151), BNP ≤ 32.2 pg/ml; group H (n=151), BNP >32.2 pg/ml. The Selvester QRS-scoring system was used to estimate infarct size. The rate of ischemia/reperfusion injury immediately after reperfusion, defined as reperfusion ventricular arrhythmias (26% vs. 11%, p=0.001) and ST-segment re-elevation (44% vs. 22%, p=0.008), was higher in group L than in group H. Group L had a greater increase in the QRS score during percutaneous coronary intervention (3.55 ± 0.17 vs. 2.09 ± 0.17, p<0.001) and a higher QRS score 1 h after percutaneous coronary intervention (5.77 ± 0.28 vs. 4.51 ± 0.28, p=0.002). On multivariate analysis, plasma BNP levels in the lower 50th percentile were an independent predictor of reperfusion injury (odds ratio, 2.620; p<0.001). The odds ratios of reperfusion injury according to decreasing quartiles of BNP level, as compared with the highest quartile, were 1.536, 3.692 and 4.964, respectively (p trend=0.002). Plasma BNP level before percutaneous coronary intervention may be a predictor of ischemia/reperfusion injury and the resultant extent of myocardial damage. Our findings suggest that high plasma BNP levels might have a clinically important protective effect on ischemic myocardium in patients with STEMI who receive percutaneous coronary intervention. © The European Society of Cardiology 2015.

Differentiating Electromechanical From Non-Electrical Substrates of Mechanical Discoordination to Identify Responders to Cardiac Resynchronization Therapy.

PubMed

Lumens, Joost; Tayal, Bhupendar; Walmsley, John; Delgado-Montero, Antonia; Huntjens, Peter R; Schwartzman, David; Althouse, Andrew D; Delhaas, Tammo; Prinzen, Frits W; Gorcsan, John

2015-09-01

Left ventricular (LV) mechanical discoordination, often referred to as dyssynchrony, is often observed in patients with heart failure regardless of QRS duration. We hypothesized that different myocardial substrates for LV mechanical discoordination exist from (1) electromechanical activation delay, (2) regional differences in contractility, or (3) regional scar and that we could differentiate electromechanical substrates responsive to cardiac resynchronization therapy (CRT) from unresponsive non-electrical substrates. First, we used computer simulations to characterize mechanical discoordination patterns arising from electromechanical and non-electrical substrates and accordingly devise the novel systolic stretch index (SSI), as the sum of posterolateral systolic prestretch and septal systolic rebound stretch. Second, 191 patients with heart failure (QRS duration ≥120 ms; LV ejection fraction ≤35%) had baseline SSI quantified by automated echocardiographic radial strain analysis. Patients with SSI≥9.7% had significantly less heart failure hospitalizations or deaths 2 years after CRT (hazard ratio, 0.32; 95% confidence interval, 0.19-0.53; P<0.001) and less deaths, transplants, or LV assist devices (hazard ratio, 0.28; 95% confidence interval, 0.15-0.55; P<0.001). Furthermore, in a subgroup of 113 patients with intermediate electrocardiographic criteria (QRS duration of 120-149 ms or non-left bundle branch block), SSI≥9.7% was independently associated with significantly less heart failure hospitalizations or deaths (hazard ratio, 0.41; 95% confidence interval, 0.23-0.79; P=0.004) and less deaths, transplants, or LV assist devices (hazard ratio, 0.27; 95% confidence interval, 0.12-0.60; P=0.001). Computer simulations differentiated patterns of LV mechanical discoordination caused by electromechanical substrates responsive to CRT from those related to regional hypocontractility or scar unresponsive to CRT. The novel SSI identified patients who benefited more favorably from CRT, including those with intermediate electrocardiographic criteria, where CRT response is less certain by ECG alone. © 2015 American Heart Association, Inc.

Mechanical dyssynchrony is additive to ECG criteria and independently associated with reverse remodelling and clinical response to cardiac resynchronisation therapy in patients with advanced heart failure

PubMed Central

Bank, Alan J; Gage, Ryan M; Marek, Josef J; Onishi, Toshinari; Burns, Kevin V; Schwartzman, David; Saba, Samir; Gorcsan, John

2015-01-01

Background QRS duration and morphology are known established predictors of cardiac resynchronisation therapy (CRT) response, whereas mechanical dyssynchrony is not. Our aim was to determine if mechanical dyssynchrony provides independent prognostic information on CRT response. Methods We studied 369 consecutive patients with heart failure (HF) with low ejection fraction (EF) and widened QRS receiving CRT. Radial dyssynchrony (septal-posterior radial peak strain delay ≥130 ms by speckle tracking) assessment was possible in 318 patients (86%). Associations with left ventricular end-systolic volume (LVESV) changes were examined using linear regression, and clinical outcomes analysed using Cox regression adjusted for multiple established outcome correlates. Results Patients with radial dyssynchrony before CRT (64%) had greater improvements in EF (8.8±9.4 vs 6.1±9.7 units, p=0.04) and LVESV (−30±41 vs −10±30 mL, p<0.01). Radial dyssynchrony was independently associated with reduction in LVESV (regression coefficient −10.5 mL, 95% CI −20.5 to −0.5, p=0.040) as was left bundle-branch block (−17.7 mL, −27.6 to −7.7, p=0.001). Patients with radial dyssynchrony had a 46% lower incidence of death, transplant or implantation of a left ventricular assist device (adjusted HR 0.54, 95% CI 0.31 to 0.92, p=0.02) and a 39% lower incidence of death or HF hospitalisation (0.61, 0.40 to 0.93, p=0.02) over 2 years. Conclusions Radial dyssynchrony was associated with significant improvements in LVESV and clinical outcomes following CRT and is independent of QRS duration or morphology, and additive to current ECG selection criteria to predict response to CRT. PMID:25973213

Functional characteristics of left ventricular synchronization via right ventricular outflow-tract pacing detected by two-dimensional strain echocardiography.

PubMed

Hirayama, Yasutaka; Kawamura, Yuichiro; Sato, Nobuyuki; Saito, Tatsuya; Tanaka, Hideichi; Saijo, Yasuaki; Kikuchi, Kenjiro; Ohori, Katsumi; Hasebe, Naoyuki

2017-02-01

Recently, due to the detrimental effects on the ventricular function associated with right ventricular apical (RVA) pacing, right ventricular septal (RVS) pacing has become the preferred pacing method. However, the term RVS pacing refers to both right ventricular outflow-tract (RVOT) and mid-septal (RVMS) pacing, leading to a misinterpretation of the results of clinical studies. The purpose of this study, therefore, was to elucidate the functional differences of RVA, RVOT, and RVMS pacing in patients with atrioventricular block. We compared the QRS duration, global longitudinal strain (GLS), and left ventricular (LV) synchronization parameters at the three pacing sites in 47 patients. The peak systolic strain (PSS) time delay between the earliest and latest segments among the 18 LV segments and standard deviation (SD) of the time to the PSS were also calculated for the 18 LV segments at each pacing site using two-dimensional (2D) strain echocardiography. RVMS pacing was associated with a significantly shorter QRS duration compared with RVA and RVOT pacing (154.4±21.4 vs 186.5±19.9 and 171.1±21.5 ms, P <0.001). In contrast, RVOT pacing revealed a greater GLS (-14.69±4.92 vs -13.12±4.76 and -13.51±4.81%, P <0.001), shorter PSS time delay between the earliest and latest segments (236.0±87.9 vs 271.3±102.9 and 281.9±126.6%, P =0.007), and shorter SD of the time to the PSS (70.8±23.8 vs 82.7±30.8 and 81.5±33.7 ms, P =0.002) compared with RVA and RVMS pacing. These results suggest that the functional characteristics of RVOT pacing may be a more optimal pacing site than RVMS, regardless of the pacing QRS duration, in patients with atrioventricular conduction disorders.

Resolution Quality and Atom Positions in Sub-Angstrom Electron Microscopy

DOE Office of Scientific and Technical Information (OSTI.GOV)

O'Keefe, Michael A.; Allard, Lawrence F.; Blom, Douglas A.

2005-02-15

Ability to determine whether an image peak represents one single atom or several depends on resolution of the HR-(S)TEM. Rayleigh's resolution criterion, an accepted standard in optics, was derived as a means for judging when two image intensity peaks from two sources of light (stars) are distinguishable from a single source. Atom spacings closer than the Rayleigh limit have been resolved in HR-TEM, suggesting that it may be useful to consider other limits, such as the Sparrow resolution criterion. From the viewpoint of the materials scientist, it is important to be able to use the image to determine whether anmore » image feature represents one or more atoms (resolution), and where the atoms (or atom columns) are positioned relative to one another (resolution quality). When atoms and the corresponding image peaks are separated by more than the Rayleigh limit of the HR-(S)TEM, it is possible to adjust imaging parameters so that relative peak positions in the image correspond to relative atom positions in the specimen. When atoms are closer than the Rayleigh limit, we must find the relationship of the peak position to the atom position by peak fitting or, if we have a suitable model, by image simulation. Our Rayleigh-Sparrow parameter QRS reveals the ''resolution quality'' of a microscope image. QRS values greater than 1 indicate a clearly resolved twin peak, while values between 1 and 0 mean a lower-quality resolution and an image with peaks displaced from the relative atom positions. The depth of the twin-peak minimum can be used to determine the value of QRS and the true separation of the atom peaks that sum to produce the twin peak in the image. The Rayleigh-Sparrow parameter can be used to refine relative atom positions in defect images where atoms are closer than the Rayleigh limit of the HR-(S)TEM, reducing the necessity for full image simulations from large defect models.« less

A feasible approach for direct his-bundle pacing using a new steerable catheter to facilitate precise lead placement.

PubMed

Zanon, Francesco; Baracca, Enrico; Aggio, Silvio; Pastore, Gianni; Boaretto, Graziano; Cardano, Paola; Marotta, Tiziana; Rigatelli, Gianluca; Galasso, Mariapaola; Carraro, Mauro; Zonzin, Pietro

2006-01-01

Much clinical evidence has shown that right ventricular (RV) apical pacing is detrimental to left ventricular function. Preservation of the use of the His-Purkinje (H-P) system may be ideal in heart block that is restricted to the AV node, but may be of no benefit when H-P disease exists. To investigate the feasibility of direct His-bundle pacing (DHBP) using a new system consisting of a steerable catheter and a new 4.1 F screw-in lead. Between May and December 2004, 26 patients (19 male, mean age: 77 +/- 5 years) with a standard pacemaker (PM) indication and preserved His-bundle conduction were enrolled and DHBP was attempted. DHBP was achieved in 24 patients (92%); two patients were paced in the His area, but the paced QRS morphology and duration were different from the native QRS. The mean time for lead positioning was 19 +/- 17 minutes, the mean fluoroscopy time was 11 +/- 8 minutes, and the total procedure time (skin-to-skin including positioning of a quadripolar diagnostic catheter for His recording) was 75 +/- 18 minutes. In DHBP pacing, the acute pacing threshold was 2.3 +/- 1.0 V at a pulse duration of 0.5 msec, and the sensed potentials were 2.9 +/- 2.0 mV. At a 3-month follow-up examination, the same QRS duration and morphology recorded on implantation were observed in all patients. The pacing threshold was 2.8 +/- 1.4 V, and sensed potentials were 2.5 +/- 1.8 mV; the sensing configuration was changed from bipolar to unipolar in 6 patients to resolve undersensing issues. No major complications were observed. This feasibility study shows that DHBP can be accomplished with a new system consisting of a steerable catheter and an active fixation lead in 92% of the patients in whom it was attempted.

Prevalence and clinical significance of left bundle branch block according to classical or strict definition criteria in permanent pacemaker patients.

PubMed

Mazza, Andrea; Bendini, Maria Grazia; De Cristofaro, Raffaele; Lovecchio, Mariolina; Valsecchi, Sergio; Leggio, Massimo; Boriani, Giuseppe

2017-06-01

Previous studies have shown that the presence of left bundle branch block (LBBB) is associated with an increased risk of cardiac mortality and heart failure (HF). Recently, new criteria to define strict LBBB have been proposed: QRS duration ≥140 ms for men and ≥130 ms for women, along with mid-QRS notching or slurring in ≥2 contiguous leads. We assessed the prevalence and prognostic significance of LBBB according to classical (QRS duration ≥120ms) and strict criteria in permanent pacemaker patients. We retrospectively enrolled 723 consecutive patients who had undergone single- or dual-chamber pacemaker implantation at the study center from July 2002 to December 2014. Patients with a left ventricular ejection fraction ≤35% or a prior diagnosis of HF were excluded. LBBB was reported in 54 (7%) patients, and strict-LBBB in 15 (2%) patients. During a median follow-up of 48 months (range, 18-92 months), 147 (20%) patients reached the combined endpoint of death or HF hospitalization. Patients with LBBB and those with strict-LBBB displayed significantly higher rates of death or HF hospitalization (log-rank test, all P < 0.0001). In particular, strict-LBBB was associated with the worst outcome. The presence of LBBB according to classical definition criteria (hazard ratio [HR] = 1.98, confidence interval [CI]: 1.23-3.19, P = 0.005) and to strict criteria (HR = 2.20; CI: 1.04-4.65; P = 0.039) were both confirmed as independent predictors of death or HF hospitalization after adjustment for relevant clinical covariates. Among patients who had undergone standard pacemaker implantation, the prevalence of LBBB was 7% according to classical definition criteria and 2% according to strict criteria. The presence of LBBB, and particularly of strict-LBBB, at the baseline predicted a poor outcome in terms of death or HF hospitalization. © 2017 Wiley Periodicals, Inc.

Can Functional Cardiac Age be Predicted from ECG in a Normal Healthy Population

NASA Technical Reports Server (NTRS)

Schlegel, Todd; Starc, Vito; Leban, Manja; Sinigoj, Petra; Vrhovec, Milos

2011-01-01

In a normal healthy population, we desired to determine the most age-dependent conventional and advanced ECG parameters. We hypothesized that changes in several ECG parameters might correlate with age and together reliably characterize the functional age of the heart. Methods: An initial study population of 313 apparently healthy subjects was ultimately reduced to 148 subjects (74 men, 84 women, in the range from 10 to 75 years of age) after exclusion criteria. In all subjects, ECG recordings (resting 5-minute 12-lead high frequency ECG) were evaluated via custom software programs to calculate up to 85 different conventional and advanced ECG parameters including beat-to-beat QT and RR variability, waveform complexity, and signal-averaged, high-frequency and spatial/spatiotemporal ECG parameters. The prediction of functional age was evaluated by multiple linear regression analysis using the best 5 univariate predictors. Results: Ignoring what were ultimately small differences between males and females, the functional age was found to be predicted (R2= 0.69, P < 0.001) from a linear combination of 5 independent variables: QRS elevation in the frontal plane (p<0.001), a new repolarization parameter QTcorr (p<0.001), mean high frequency QRS amplitude (p=0.009), the variability parameter % VLF of RRV (p=0.021) and the P-wave width (p=0.10). Here, QTcorr represents the correlation between the calculated QT and the measured QT signal. Conclusions: In apparently healthy subjects with normal conventional ECGs, functional cardiac age can be estimated by multiple linear regression analysis of mostly advanced ECG results. Because some parameters in the regression formula, such as QTcorr, high frequency QRS amplitude and P-wave width also change with disease in the same direction as with increased age, increased functional age of the heart may reflect subtle age-related pathologies in cardiac electrical function that are usually hidden on conventional ECG.

The arterial baroreflex effectiveness index in risk stratification of chronic heart failure patients who are candidates for cardiac resynchronization therapy.

PubMed

Fernandes Serôdio, João; Martins Oliveira, Mário; Matoso Laranjo, Sérgio; Tavares, Cristiano; Silva Cunha, Pedro; Abreu, Ana; Branco, Luísa; Alves, Sandra; Rocha, Isabel; Cruz Ferreira, Rui

2016-06-01

Baroreflex function is an independent marker of prognosis in heart failure (HF). However, little is known about its relation to response to cardiac resynchronization therapy (CRT). The aim of this study is to assess arterial baroreflex function in HF patients who are candidates for CRT. The study population consisted of 25 patients with indication for CRT, aged 65±10 years, NYHA functional class ≥III in 52%, QRS width 159±15 ms, left ventricular ejection fraction (LVEF) 29±5%, left ventricular end-systolic volume (LVESV) 150±48 ml, B-type natriuretic peptide (BNP) 357±270 pg/ml, and peak oxygen consumption (peak VO2) 18.4±5.0 ml/kg/min. An orthostatic tilt test was performed to assess the baroreflex effectiveness index (BEI) by the sequence method. This group was compared with 15 age-matched healthy individuals. HF patients showed a significantly depressed BEI during tilt (31±12% vs. 49±18%, p=0.001). A lower BEI was associated with higher BNP (p=0.038), lower peak VO2 (p=0.048), and higher LVESV (p=0.031). By applying a cut-off value of 25% for BEI, two clusters of patients were identified: lower risk cluster (BEI >25%) QRS 153 ms, LVESV 129 ml, BNP 146 pg/ml, peak VO2 19.0 ml/kg/min; and higher risk cluster (IEB ≤25%) QRS 167 ms, LVESV 189 ml, BNP 590 pg/ml, peak VO2 16.2 ml/kg/min. Candidates for CRT show depressed arterial baroreflex function. Lower BEI was observed in high-risk HF patients. Baroreflex function correlated closely with other clinical HF parameters. Therefore, BEI may improve risk stratification in HF patients undergoing CRT. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

Cardiac sodium channel blockade after an intentional ingestion of lacosamide, cyclobenzaprine, and levetiracetam: Case report.

PubMed

Chua-Tuan, Jenny L; Cao, Dazhe; Iwanicki, Janetta L; Hoyte, Christopher O

2015-07-01

Lacosamide treats partial seizures by enhancing slow inactivation of voltage-gated sodium channels. The described cardiac toxicity of lacosamide in the literature to date includes atrioventricular blockade (PR prolongation), atrial flutter, atrial fibrillation, sinus pauses, ventricular tachycardia and a single cardiac arrest. We report a second case of cardiac arrest following an intentional lacosamide overdose. A 16 year-old female with a seizure disorder was found unresponsive in pulseless ventricular tachycardia after intentionally ingesting 4.5 g (76 mg/kg) lacosamide, 120 mg (2 mg/kg) cyclobenzaprine and an unknown amount of levetiracetam. Exact time of ingestion was unknown. Her initial electrocardiogram (ECG) demonstrated sinus tachycardia at 139 beats per minute, QRS duration 112 ms, and terminal R-wave in lead aVR > 3 mm. Despite treatment with 150 mEq of sodium bicarbonate, she had persistent EKG findings eight hours after presentation. Her serum lacosamide concentration nine hours after presentation was elevated at 22.8 μg/mL, while serum cyclobenzaprine concentration was 16 ng/mL (therapeutic: 10-30 ng/mL), and serum levetiracetam concentration was 22.7 μg/mL (therapeutic: 12-46 μg/mL). On hospital day three, ECG demonstrated resolution of the terminal R-wave with QRS of 78 ms. The patient recovered without physical or neurologic sequelae. The patient's lacosamide, cyclobenzaprine and levetiracetam overdose was associated with QRS prolongation and terminal right axis deviation--suggesting sodium channel blockade as a likely etiology for her cardiac arrest. Cyclobenzaprine has potential for sodium channel blockade and ventricular dysrhythmias although cardiac toxicity due to cyclobenzaprine alone is rare. The combination of cyclobenzaprine with lacosamide may have resulted in cardiovascular collapse. In conclusion, overdose of lacosamide combined with therapeutic concentrations of sodium channel blocking xenobiotics may cause cardiac conduction delays and cardiac arrest.

Ethnic differences in the association of QRS duration with ejection fraction and outcome in heart failure

PubMed Central

Gijsberts, Crystel M; Benson, Lina; Dahlström, Ulf; Sim, David; Yeo, Daniel P S; Ong, Hean Yee; Jaufeerally, Fazlur; Leong, Gerard K T; Ling, Lieng H; Richards, A Mark; de Kleijn, Dominique P V; Lund, Lars H; Lam, Carolyn S P

2016-01-01

Background QRS duration (QRSd) criteria for device therapy in heart failure (HF) were derived from predominantly white populations and ethnic differences are poorly understood. Methods We compared the association of QRSd with ejection fraction (EF) and outcomes between 839 Singaporean Asian and 11 221 Swedish white patients with HF having preserved EF (HFPEF)and HF having reduced EF (HFREF) were followed in prospective population-based HF studies. Results Compared with whites, Asian patients with HF were younger (62 vs 74 years, p<0.001), had smaller body size (height 163 vs 171 cm, weight 70 vs 80 kg, both p<0.001) and had more severely impaired EF (EF was <30% in 47% of Asians vs 28% of whites). Overall, unadjusted QRSd was shorter in Asians than whites (101 vs 104 ms, p<0.001). Lower EF was associated with longer QRSd (p<0.001), with a steeper association among Asians than whites (pinteraction<0.001), independent of age, sex and clinical covariates (including body size). Excluding patients with left bundle branch block (LBBB) and adjusting for clinical covariates, QRSd was similar in Asians and whites with HFPEF, but longer in Asians compared with whites with HFREF (p=0.001). Longer QRSd was associated with increased risk of HF hospitalisation or death (absolute 2-year event rate for ≤120 ms was 40% and for >120 ms it was 52%; HR for 10 ms increase of QRSd was 1.04 (1.03 to 1.06), p<0.001), with no interaction by ethnicity. Conclusion We found ethnic differences in the association between EF and QRSd among patients with HF. QRS prolongation was similarly associated with increased risk, but the implications for ethnicity-specific QRSd cut-offs in clinical decision-making require further study. PMID:27402805

Protective effects of Hawthorn (Crataegus oxyacantha) extract against digoxin-induced arrhythmias in rats.

PubMed

Alp, Hayrullah; Soner, Burak Cem; Baysal, Tamer; Şahin, Ayşe Saide

2015-01-01

Digitalis preparations are commonly used by children and adults with heart diseases worldwide, although excessive doses may cause cardiac effects. The aim of the study is to evaluate the antiarrhythmic effect of Crataegus oxyacantha extract on digoxin-induced arrhythmias in anesthetized Wistar rats. Control and experimental groups were evaluated for arrhythmias induced by digoxin. Fifteen rats (7 as controls and 8 as the experimental group) were included in the study. The dry fruits of 100 mg Crataegus oxyacantha were extracted by percolation method. Digoxin, at a dose of 40 µg/kg/min, was infused to form the arrhythmias in all rats. Simultaneously, the extract was infused into the experimental group, while 0.9% NaCl was infused into control group. Electrocardiographic QRS prolongation and arterial blood pressure changes were analyzed. The experimental group lived longer (62.13±2.20 min) than the controls (p=0.002). On the other hand, the time to beginning of QRS prolongation did not differ between the two groups (p=0.812). Bradycardia was significant in the control group (288.01±10.54 beat/min and p=0.01). The maximum QRS duration was observed in the control group during the digoxin and 0.9% NaCl infusion period (53.29±3.99 ms and p=0.001). Also, the durations of atrial and ventricular arrhythmias were shorter in the experimental group. However, arterial blood pressure dipping was significant in the experimental group (23.67±10.89 mm Hg and p<0.001). Crataegus oxyacantha alcoholic extract produced an antiarrhythmic effect that was induced by digoxin in Wistar rats. However, in the clinical use of this extract, the hypotensive effect should be considered. Also, the alcoholic extract of Crataegus oxyacantha may be an alternative treatment medication for arrhythmias induced by digoxin toxicity in humans.

Protective effects of Hawthorn (Crataegus oxyacantha) extract against digoxin-induced arrhythmias in rats

PubMed Central

Alp, Hayrullah; Soner, Burak Cem; Baysal, Tamer; Şahin, Ayşe Saide

2016-01-01

Objective: Digitalis preparations are commonly used by children and adults with heart diseases worldwide, although excessive doses may cause cardiac effects. The aim of the study is to evaluate the antiarrhythmic effect of Crataegus oxyacantha extract on digoxin-induced arrhythmias in anesthetized Wistar rats. Methods: Control and experimental groups were evaluated for arrhythmias induced by digoxin. Fifteen rats (7 as controls and 8 as the experimental group) were included in the study. The dry fruits of 100 mg Crataegus oxyacantha were extracted by percolation method. Digoxin, at a dose of 40 μg/kg/min, was infused to form the arrhythmias in all rats. Simultaneously, the extract was infused into the experimental group, while 0.9% NaCl was infused into control group. Electrocardiographic QRS prolongation and arterial blood pressure changes were analyzed. Results: The experimental group lived longer (62.13±2.20 min) than the controls (p=0.002). On the other hand, the time to beginning of QRS prolongation did not differ between the two groups (p=0.812). Bradycardia was significant in the control group (288.01±10.54 beat/min and p=0.01). The maximum QRS duration was observed in the control group during the digoxin and 0.9% NaCl infusion period (53.29±3.99 ms and p=0.001). Also, the durations of atrial and ventricular arrhythmias were shorter in the experimental group. However, arterial blood pressure dipping was significant in the experimental group (23.67±10.89 mm Hg and p<0.001). Conclusion: Crataegus oxyacantha alcoholic extract produced an antiarrhythmic effect that was induced by digoxin in Wistar rats. However, in the clinical use of this extract, the hypotensive effect should be considered. Also, the alcoholic extract of Crataegus oxyacantha may be an alternative treatment medication for arrhythmias induced by digoxin toxicity in humans. PMID:25880053

Development of a Multi-Channel, High Frequency QRS Electrocardiograph

NASA Technical Reports Server (NTRS)

DePalma, Jude L.

2003-01-01

With the advent of the ISS era and the potential requirement for increased cardiovascular monitoring of crewmembers during extended EVAs, NASA flight surgeons would stand to benefit from an evolving technology that allows for a more rapid diagnosis of myocardial ischemia compared to standard electrocardiography. Similarly, during the astronaut selection process, NASA flight surgeons and other physicians would also stand to benefit from a completely noninvasive technology that, either at rest or during maximal exercise tests, is more sensitive than standard ECG in identifying the presence of ischemia. Perhaps most importantly, practicing cardiologists and emergency medicine physicians could greatly benefit from such a device as it could augment (or even replace) standard electrocardiography in settings where the rapid diagnosis of myocardial ischemia (or the lack thereof) is required for proper clinical decision-making. A multi-channel, high-frequency QRS electrocardiograph is currently under development in the Life Sciences Research Laboratories at JSC. Specifically the project consisted of writing software code, some of which contained specially-designed digital filters, which will be incorporated into an existing commercial software program that is already designed to collect, plot and analyze conventional 12-lead ECG signals on a desktop, portable or palm PC. The software will derive the high-frequency QRS signals, which will be analyzed (in numerous ways) and plotted alongside of the conventional ECG signals, giving the PC-viewing clinician advanced diagnostic information that has never been available previously in all 12 ECG leads simultaneously. After the hardware and software for the advanced digital ECG monitor have been fully integrated, plans are to use the monitor to begin clinical studies both on healthy subjects and on patients with known coronary artery disease in both the outpatient and hospital settings. The ultimate goal is to get the technology out into the clinical world, where it has the potential to save lives.

The value of the 12-lead electrocardiogram in localizing the scar in non-ischaemic cardiomyopathy.

PubMed

Oloriz, Teresa; Wellens, Hein J J; Santagostino, Giulia; Trevisi, Nicola; Silberbauer, John; Peretto, Giovanni; Maccabelli, Giuseppe; Della Bella, Paolo

2016-12-01

Patients with non-ischaemic cardiomyopathy (NICM) and ventricular tachycardia can be categorized as anteroseptal (AS) or inferolateral (IL) scar sub-types based on imaging and voltage mapping studies. The aim of this study was to correlate the baseline electrocardiogram (ECG) with endo-epicardial voltage maps created during ablation procedures and identify the ECG characteristics that may help to distinguish the scar as AS or IL. We assessed 108 baseline ECGs; 72 patients fulfilled criteria for dilated cardiomyopathy whereas 36 showed minimal structural abnormalities. Based on the unipolar low-voltage distribution, the scar pattern was classified as predominantly AS (n = 59) or IL (n = 49). Three ECG criteria (PR interval < 170 ms or QRS voltage in inferior leads <0.6 mV or a lateral q wave) resulted in 92% sensitivity and 90% specificity for predicting an IL pattern in patients with preserved ejection fraction (EF). The four-step algorithm for dilated cardiomyopathy included a paced ventricular rhythm or PR > 230 ms or QRS > 170 ms or an r ≤ 0.3 mV in V3 having 92 and 81% of sensitivity and specificity, respectively, in predicting AS scar pattern. A significant negative correlation was found between the extension of the endocardial unipolar low voltage area and left ventricular EF (r s = -0.719, P < 0.001). The extent of endocardial AS unipolar low voltage was correlated with PR interval and QRS duration (r s = 0.583 and r s = 0.680, P < 0.001, respectively) and the IL epicardial unipolar low voltage with the mean voltage of the limb leads (r s = -0.639, P < 0.001). Baseline ECG features are well correlated with the distribution of unipolar voltage abnormalities in NICM and may help to predict the location of scar in this population. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

"J waves" induced after short coupling intervals: a manifestations of latent depolarization abnormality?

PubMed

Aizawa, Yoshifusa; Nakayama, Masafumi; Sato, Masahito; Okabe, Masaaki; Aizawa, Yoshiyasu; Takatsuki, Seiji; Fukuda, Keiichi

2017-04-24

To confirm the presence of tachycardia-induced slur or notch in the terminal portion of the QRS complexes in a general patient population. A tachycardia-induced J wave was defined as a slur or notch in the terminal portion of the QRS complexes newly induced at short RR intervals during atrial premature contractions (APCs) or atrial electrical stimulation in the electrophysiological study (EPS). Twenty-three out of 2000 patients with general diseases were involved. All patients with aborted sudden cardiac death, ventricular fibrillation or a family history of sudden cardiac death were excluded. The mean age was 72 ± 9 years, and 11 patients were male (47.8%). When the RR interval was shortened from 821 ± 142 ms to 464 ± 52 ms in the conducted APCs (P < 0.0001), J waves became diagnostic (0.02 ± 0.03 mV to 0.20 ± 0.07 mV, P < 0.0001). J waves were confined to the inferior leads in 22 (95.7%) patients and were notched in 11 (47.8%) and slurred in 12 (52.2%) patients. The induction of J waves was accompanied by visible changes of the QRS morphology. When the post-APC RR interval was prolonged to 992 ± 305 ms (P = 0.0154 vs. baseline), the J waves were similar to baseline levels. During the EPS, J wave induction was confirmed during atrial stimulation. There were no characteristic clinical or ECG features in the patients with tachycardia-induced J waves. J waves can be newly induced by short RR intervals in a general patient population, and a conduction delay is the likely mechanism causing such J waves. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For Permissions, please email: journals.permissions@oup.com.

Use of artificial intelligence to identify cardiovascular compromise in a model of hemorrhagic shock.

PubMed

Glass, Todd F; Knapp, Jason; Amburn, Philip; Clay, Bruce A; Kabrisky, Matt; Rogers, Steven K; Garcia, Victor F

2004-02-01

To determine whether a prototype artificial intelligence system can identify volume of hemorrhage in a porcine model of controlled hemorrhagic shock. Prospective in vivo animal model of hemorrhagic shock. Research foundation animal surgical suite; computer laboratories of collaborating industry partner. Nineteen, juvenile, 25- to 35-kg, male and female swine. Anesthetized animals were instrumented for arterial and systemic venous pressure monitoring and blood sampling, and a splenectomy was performed. Following a 1-hr stabilization period, animals were hemorrhaged in aliquots to 10, 20, 30, 35, 40, 45, and 50% of total blood volume with a 10-min recovery between each aliquot. Data were downloaded directly from a commercial monitoring system into a proprietary PC-based software package for analysis. Arterial and venous blood gas values, glucose, and cardiac output were collected at specified intervals. Electrocardiogram, electroencephalogram, mixed venous oxygen saturation, temperature (core and blood), mean arterial pressure, pulmonary artery pressure, central venous pressure, pulse oximetry, and end-tidal CO(2) were continuously monitored and downloaded. Seventeen of 19 animals (89%) died as a direct result of hemorrhage. Stored data streams were analyzed by the prototype artificial intelligence system. For this project, the artificial intelligence system identified and compared three electrocardiographic features (R-R interval, QRS amplitude, and R-S interval) from each of nine unknown samples of the QRS complex. We found that the artificial intelligence system, trained on only three electrocardiographic features, identified hemorrhage volume with an average accuracy of 91% (95% confidence interval, 84-96%). These experiments demonstrate that an artificial intelligence system, based solely on the analysis of QRS amplitude, R-R interval, and R-S interval of an electrocardiogram, is able to accurately identify hemorrhage volume in a porcine model of lethal hemorrhagic shock. We suggest that this technology may represent a noninvasive means of assessing the physiologic state during and immediately following hemorrhage. Point of care application of this technology may improve outcomes with earlier diagnosis and better titration of therapy of shock.

QRS/T-wave and calcium alternans in a type I diabetic mouse model for spontaneous postmyocardial infarction ventricular tachycardia: A mechanism for the antiarrhythmic effect of statins.

PubMed

Jin, Hongwei; Welzig, Charles M; Aronovitz, Mark; Noubary, Farzad; Blanton, Robert; Wang, Bo; Rajab, Mohammad; Albano, Alfred; Link, Mark S; Noujaim, Sami F; Park, Ho-Jin; Galper, Jonas B

2017-09-01

The incidence of sudden arrhythmic death is markedly increased in diabetics. The purpose of this study was to develop a mouse model for postmyocardial infarction (post-MI) ventricular tachycardia (VT) in the diabetic heart and determine the mechanism of an antiarrhythmic effect of statins. ECG transmitters were implanted in wild-type (WT), placebo, and pravastatin-treated type I diabetic Akita mice. MIs were induced by coronary ligation, and Ca 2+ transients were studied by optical mapping, and Ca 2+ transients and sparks in left ventricular myocytes (VM) by the Ionoptix system and confocal microscopy. Burst pacing of Akita mouse hearts resulted in rate-related QRS/T-wave alternans, which was attenuated in pravastatin-treated mice. Post-MI Akita mice developed QRS/T-wave alternans and VT at 2820 ± 879 beats per mouse, which decreased to 343 ± 115 in pravastatin-treated mice (n = 13, P <.05). Optical mapping demonstrated pacing-induced VT originating in the peri-infarction zone and Ca 2+ alternans, both attenuated in hearts of statin-treated mice. Akita VM displayed Ca 2+ alternans, and triggered activity as well as increased Ca 2+ transient decay time (Tau), Ca 2+ sparks, and cytosolic Ca 2+ and decreased SR Ca 2+ stores all of which were in part reversed in cells from statin treated mice. Homogenates of Akita ventricles demonstrated decreased SERCA2a/PLB ratio and increased ratio of protein phosphatase (PP-1) to the PP-1 inhibitor PPI-1 which were reversed in homogenates of pravastatin-treated Akita mice. Pravastatin decreased the incidence of post-MI VT and Ca 2+ alternans in Akita mouse hearts in part by revering abnormalities of Ca 2+ handling via the PP-1/PPI-1 pathway. Copyright © 2017 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Selective activation of the K(+)(ATP) channel is a mechanism by which sudden death is produced by low-energy chest-wall impact (Commotio cordis).

PubMed

Link, M S; Wang, P J; VanderBrink, B A; Avelar, E; Pandian, N G; Maron, B J; Estes, N A

1999-07-27

Sudden death due to relatively innocent chest-wall impact has been described in young individuals (commotio cordis). In our previously reported swine model of commotio cordis, ventricular fibrillation (with T-wave strikes) and ST-segment elevation (with QRS strikes) were produced by 30-mph baseball impacts to the precordium. Because activation of the K(+)(ATP) channel has been implicated in the pathogenesis of ST elevation and ventricular fibrillation in myocardial ischemia, we hypothesized that this channel could be responsible for the electrophysiologic findings in our experimental model and in victims of commotio cordis. In the initial experiment, 6 juvenile swine were given 0.5 mg/kg IV glibenclamide, a selective inhibitor of the K(+)(ATP) channel, and chest impact was given on the QRS. The results of these strikes were compared with animals in which no glibenclamide was given. In the second phase, 20 swine were randomized to receive glibenclamide or a control vehicle (in a double-blind fashion), with chest impact delivered just before the T-wave peak. With QRS impacts, the maximal ST elevation was significantly less in those animals given glibenclamide (0.16+/-0.10 mV) than in controls (0.35+/-0.20 mV; P=0.004). With T-wave impacts, the animals that received glibenclamide had significantly fewer occurrences of ventricular fibrillation (1 episode in 27 impacts; 4%) than controls (6 episodes in 18 impacts; 33%; P=0.01). In this experimental model of commotio cordis, blockade of the K(+)(ATP) channel reduced the incidence of ventricular fibrillation and the magnitude of ST-segment elevation. Therefore, selective K(+)(ATP) channel activation may be a pivotal mechanism in sudden death resulting from low-energy chest-wall trauma in young people during sporting activities.

T wave alternans threshold late after repair of tetralogy of Fallot

NASA Technical Reports Server (NTRS)

Cheung, Michael M H.; Weintraub, Robert G.; Cohen, Richard J.; Karl, Tom R.; Wilkinson, James L.; Davis, Andrew M.

2002-01-01

INTRODUCTION: Sustained microvolt-level T wave alternans (TWA) is a marker of increased risk for malignant ventricular arrhythmia. There is a significant risk of arrhythmia and sudden death after repair of congenital heart disease. The aim of this study was to determine the prevalence and characteristics of TWA after repair of tetralogy of Fallot (TOF). METHODS AND RESULTS: TWA was evaluated during bicycle exercise in 49 subjects who had consecutively undergone transatrial-transpulmonary repair. Median values for age, age at repair, and follow-up duration were 14.9 years (11.5-20.8), 1.6 years (0.2-4.9), and 11.6 years (9.4-17.2), respectively. All patients were in New York Heart Association functional class I and were asymptomatic. Median QRS duration was 120 msec (80-150). Sustained TWA was detected in 7 (23%) of 31 subjects with adequate tests. In these 7 subjects, median onset heart rate (HR) was 120 (98-155). Median HR threshold as a percentage of predicted maximum HR (220 - age) was 58% (48-77). Sustained TWA prevalence was not significantly different compared with normal subjects (7/31 vs 9/83; P = 0.1). Onset HR in the TOF group was significantly lower [mean (SD) of 122 (20) vs 139 (12), P < 0.05]. In the TOF group with sustained TWA, the TWA occurred in 4 of 7 at <60% predicted maximum HR versus 1 of 9 normal subjects (P < 0.05); 3 of 7 had onset HR <120 versus 0 of 9 normal subjects (P < 0.03). There was no significant difference in age, gender, transannular patch use, restrictive right ventricular physiology, QRS duration, QTc, QT/QRS dispersion, or nonsustained ventricular tachycardia in subjects with or those without sustained TWA. CONCLUSION: The onset HR for sustained TWA is significantly lower after repair of TOF. Further study is required to determine whether this represents an increased risk for arrhythmia in this patient group.

Crystallization and preliminary X-ray analysis of eukaryotic initiation factor 4E from Pisum sativum

PubMed Central

Ashby, Jamie A.; Stevenson, Clare E. M.; Maule, Andrew J.; Lawson, David M.

2009-01-01

Crystals of an N-terminally truncated 20 kDa fragment of Pisum sativum eIF4E (ΔN-eIF4E) were grown by vapour diffusion. X-ray data were recorded to a resolution of 2.2 Å from a single crystal in-house. Indexing was consistent with primitive monoclinic symmetry and solvent-content estimations suggested that between four and nine copies of the eIF4E fragment were possible per crystallographic asymmetric unit. eIF4E is an essential component of the eukaryotic translation machinery and recent studies have shown that point mutations of plant eIF4Es can confer resistance to potyvirus infection. PMID:19652353

[Histological study of a case of chondrocostal aspergillosis].

PubMed

Jlidi, R; Lagier, R; Abele, R; Auckenthaler, R

1988-01-01

Histological study of biopsy specimens successively taken from the 7th, 5th and 6th right chondrocostal regions in a 33 year-old man; the patient was under chemotherapy for a diffuse lymphoma and has been operated for an aspergilloma of the right lung superior lobe. Non-specific chronic osteomyelitis was observed as well as Aspergillus fumigatus perichondritis (acute and chronic) which had lead to cartilage fragmentation. Cartilage fragmentation could be attributed to an enzymatic chondrolysis induced by polymorphonuclears inflammation. Such matrix degradation seems to favour the penetration of aspergillus into the cartilage surface. This case report recalls that fungi (including Aspergillus despite it appears exceptional) must be considered as a possible cause of osteomyelitis, particularly in immunosuppressed patients.

Discovery of a basaltic asteroid in the outer main belt

PubMed

Lazzaro; Michtchenko; Carvano; Binzel; Bus; Burbine; Mothe-Diniz; Florczak; Angeli; Harris

2000-06-16

Visible and near-infrared spectroscopic observations of the asteroid 1459 Magnya indicate that it has a basaltic surface. Magnya is at 3. 15 astronomical units (AU) from the sun and has no known dynamical link to any family, to any nearby large asteroid, or to asteroid 4 Vesta at 2.36 AU, which is the only other known large basaltic asteroid. We show that the region of the belt around Magnya is densely filled by mean-motion resonances, generating slow orbital diffusion processes and providing a potential mechanism for removing other basaltic fragments that may have been created on the same parent body as Magnya. Magnya may represent a rare surviving fragment from a larger, differentiated planetesimal that was disrupted long ago.

The electron Boltzmann equation in a plasma generated by fission fragments

NASA Technical Reports Server (NTRS)

Hassan, H. A.; Deese, J. E.

1976-01-01

A Boltzmann equation formulation is presented for the determination of the electron distribution function in a plasma generated by fission fragments. The formulation takes into consideration ambipolar diffusion, elastic and inelastic collisions, recombination and ionization, and allows for the fact that the primary electrons are not monoenergetic. Calculations for He in a tube coated with fissionable material show that, over a wide pressure and neutron flux range, the distribution function is non-Maxwellian, but the electrons are essentially thermal. Moreover, about a third of the energy of the primary electrons is transferred into the inelastic levels of He. This fraction of energy transfer is almost independent of pressure and neutron flux but increases sharply in the presence of a sustainer electric field.

Star formation in shells of colliding multi-SNe bubbles

NASA Astrophysics Data System (ADS)

Vasiliev, Evgenii O.; Shchekinov, Yuri A.

2017-12-01

It is believed that when bubbles formed by multiple supernovae explosions interact with one another, they stimulate star formation in overlapping shells. We consider the evolution of a shocked layer formed by the collision of two identical bubbles each of which originated from OB clusters of ˜ 50 members and ˜ 50 pc. The clusters are separated by 200-400 pc.We found that depending on evolutionary status of colliding bubbles the shocked layer can either be destroyed into diffuse lumps, or be fragmented into dense clumps: the former occurs in collisions of young bubbles with continuing supernovae explosions, and the latter occurs in older bubble interactions.We argue that fragmentation efficiency in shells depends on external heating: for a heating rate <˜ 1.7×10-24 erg s-1 the number of fragments formed in a collision of two old bubbles reaches several tens at t ˜ 4 Myr, while a heating rate >˜ 7 × 10-24 erg s-1 prevents fragmentation. The clumps formed in freely expanding parts of bubbles are gradually destroyed and disappear on t <˜ 1 Myr,whereas those formed in the overlapping shells survive much longer. Because of this the number of fragments in an isolated bubble begins to decrease after reaching a maximum, while in collision of two old bubbles it fluctuates around 60-70 until longer than t ˜ 5 Myr.

Substrate Diffusion Heterogeneity Controls Bacterial Competition and Coexistence

NASA Astrophysics Data System (ADS)

Dechesne, A.; Or, D.; Smets, B. F.

2005-12-01

Diffusion has long been recognized as a key process affecting bacterial physiological functions ranging from nutrient uptake to removal of metabolic waste products. In the vadose zone, significant convective flows are limited and bacteria rely primarily on diffusion for nutrient supply. Even under relatively "wet" conditions (e.g. matric potentials -20 J/kg), soil water is fragmented and exists as thin liquid films or held in crevices imposing constraints on substrate diffusion. Our objective was to investigate the role of diffusion on soil microbial diversity, by focusing on one of the processes that shapes the structure of bacterial communities: competitive interactions. We used a simplified setup, in which the substrate (citrate) fluxes were controlled by different agar gels thicknesses and spatially heterogeneous diffusive pathways were created by an impermeable film with prescribed hole sizes and patterns. Our competition experiments involved two soil bacteria: Burkholderia xenovorans LB400 and Pseudomonas putida KT2440, which were tagged with different constitutive fluorescent markers, allowing for their on line microscopic detection. The growth parameters on citrate of these strains were thoroughly assessed. B. xenovorans LB400 is the weaker competitor. As a result, this strain was outcompeted by KT2440 under high substrate diffusivity and homogeneous conditions. Conversely, the disadvantage of the weakest competitor was not so marked under low substrate diffusivity condition. These results suggest that dry conditions in soil would provide conditions allowing the sustaining of weak bacterial competitors, resulting in the maintenance of high bacterial diversity.

Avascular necrosis (AVN) of the proximal fragment in scaphoid nonunion: is intravenous contrast agent necessary in MRI?

PubMed

Schmitt, R; Christopoulos, G; Wagner, M; Krimmer, H; Fodor, S; van Schoonhoven, J; Prommersberger, K J

2011-02-01

The purpose of this prospective study is to assess the diagnostic value of intravenously applied contrast agent for diagnosing osteonecrosis of the proximal fragment in scaphoid nonunion, and to compare the imaging results with intraoperative findings. In 88 patients (7 women, 81 men) suffering from symptomatic scaphoid nonunion, preoperative MRI was performed (coronal PD-w FSE fs, sagittal-oblique T1-w SE nonenhanced and T1-w SE fs contrast-enhanced, sagittal T2*-w GRE). MRI interpretation was based on the intensity of contrast enhancement: 0 = none, 1 = focal, 2 = diffuse. Intraoperatively, the osseous viability was scored by means of bleeding points on the osteotomy site of the proximal scaphoid fragment: 0=absent, 1 = moderate, 2 = good. Intraoperatively, 17 necrotic, 29 compromised, and 42 normal proximal fragments were found. In nonenhanced MRI, bone viability was judged necrotic in 1 patient, compromised in 20 patients, and unaffected in 67 patients. Contrast-enhanced MRI revealed 14 necrotic, 21 compromised, and 53 normal proximal fragments. Judging surgical findings as the standard of reference, statistical analysis for nonenhanced MRI was: sensitivity 6.3%, specificity 100%, positive PV 100%, negative PV 82.6%, and accuracy 82.9%; statistics for contrast-enhanced MRI was: sensitivity 76.5%, specificity 98.6%, positive PV 92.9%, negative PV 94.6%, and accuracy 94.3%. Sensitivity for detecting avascular proximal fragments was significantly better (p<0.001) in contrast-enhanced MRI in comparison to nonenhanced MRI. Viability of the proximal fragment in scaphoid nonunion can be significantly better assessed with the use of contrast-enhanced MRI as compared to nonenhanced MRI. Bone marrow edema is an inferior indicator of osteonecrosis. Application of intravenous gadolinium is recommended for imaging scaphoid nonunion. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

From Vulcanian explosions to sustained explosive eruptions: The role of diffusive mass transfer in conduit flow dynamics

NASA Astrophysics Data System (ADS)

Mason, R. M.; Starostin, A. B.; Melnik, O. E.; Sparks, R. S. J.

2006-05-01

Magmatic explosive eruptions are influenced by mass transfer processes of gas diffusion into bubbles caused by decompression. Melnik and Sparks [Melnik, O.E., Sparks, R.S.J. 2002, Modelling of conduit flow dynamic during explosive activity at Soufriere Hills Volcano, Montserrat. In: Druitt, T.H., Kokelaar, B.P. (eds). The Eruption of Soufriere Hills Volcano, Montserrat, from 1995 to 1999. Geological Society, London, Memoirs, 21, 307-317] proposed two end member cases corresponding to complete equilibrium and complete disequilibrium. In the first case, diffusion is fast enough to maintain the system near equilibrium and a long-lived explosive eruption develops. In the latter case, pre-existing bubbles expand under conditions of explosive eruption and decompression, but diffusive gas transfer is negligible. This leads to a much shorter eruption. Here we develop this model to consider the role of mass transfer by investigating transient flows at the start of an explosive eruption triggered by a sudden decompression. The simulations reveal a spectrum of behaviours from sustained to short-lived highly non-equilibrium Vulcanian-style explosions lasting a few tens of seconds, through longer lasting eruptions that can be sustained for tens of minutes and finally to eruptions that can last hours or even days. Behaviour is controlled by a mass-transfer parameter, ω, which equals n*2/3D, where n* is the bubble number density and D is the diffusivity. The parameter ω is expected to vary between 10 - 5 and 1 s - 1 in nature and reflects a time-scale for efficient diffusion. The spectrum of model behaviours is consistent with variations in styles of explosive eruptions of silicic volcanoes. In the initial stages peak discharges occur over 10-20 s and then decline to low discharges. If a critical bubble overpressure is assumed to be the criterion for fragmentation then fragmentation may stop and start several times in the declining period causing several pulses of high-intensity discharge. For the cases of strong disequilibria, the fluxes can decrease to negligible values where other processes, such as gas escape through permeable magma, prevents explosive conditions becoming re-established so that explosive activity stops and dome growth can start. For cases closer to the equilibrium the eruption can evolve towards a quasi-steady sustained flow, never declining sufficiently for gas escape to become dominant.

8. Photocopy of architectural drawing (from blueprint at Fort Myer ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

8. Photocopy of architectural drawing (from blueprint at Fort Myer Engineer Activity) 'Double set of Non-Commissioned Officers Qrs.' Quartermaster Generals Office, sheets 2 and 3, standard plan 23, June 1891, Lithographed on linen architectural drawing. 1 PLAN, 3 ELEVATIONS - Fort Myer, Non-Commissioned Officers Quarters, Washington Avenue between Johnson Lane & Custer Road, Arlington, Arlington County, VA

40 CFR 52.120 - Identification of plan.

Code of Federal Regulations, 2011 CFR

2011-07-01

.... (i) Incorporation by reference. (A) Arizona Revised Statutes. (1) Senate Bill 1360: Section 6: ARS 15-1444-C (added), Section 7: QRS 15-1627-F (added), Section 21: ARS 49- 542-A (amended, Section 21: ARS 49-542-E (added), Section 21: ARS 49-542-J.3.(b) (amended), and Section 23: ARS 49-550-E (added...

40 CFR 52.120 - Identification of plan.

Code of Federal Regulations, 2012 CFR

2012-07-01

.... (i) Incorporation by reference. (A) Arizona Revised Statutes. (1) Senate Bill 1360: Section 6: ARS 15-1444-C (added), Section 7: QRS 15-1627-F (added), Section 21: ARS 49- 542-A (amended, Section 21: ARS 49-542-E (added), Section 21: ARS 49-542-J.3.(b) (amended), and Section 23: ARS 49-550-E (added...

40 CFR 52.120 - Identification of plan.

Code of Federal Regulations, 2014 CFR

2014-07-01

.... (i) Incorporation by reference. (A) Arizona Revised Statutes. (1) Senate Bill 1360: Section 6: ARS 15-1444-C (added), Section 7: QRS 15-1627-F (added), Section 21: ARS 49- 542-A (amended, Section 21: ARS 49-542-E (added), Section 21: ARS 49-542-J.3.(b) (amended), and Section 23: ARS 49-550-E (added...

40 CFR 52.120 - Identification of plan.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... (i) Incorporation by reference. (A) Arizona Revised Statutes. (1) Senate Bill 1360: Section 6: ARS 15-1444-C (added), Section 7: QRS 15-1627-F (added), Section 21: ARS 49- 542-A (amended, Section 21: ARS 49-542-E (added), Section 21: ARS 49-542-J.3.(b) (amended), and Section 23: ARS 49-550-E (added...

40 CFR 52.120 - Identification of plan.

Code of Federal Regulations, 2013 CFR

2013-07-01

.... (i) Incorporation by reference. (A) Arizona Revised Statutes. (1) Senate Bill 1360: Section 6: ARS 15-1444-C (added), Section 7: QRS 15-1627-F (added), Section 21: ARS 49- 542-A (amended, Section 21: ARS 49-542-E (added), Section 21: ARS 49-542-J.3.(b) (amended), and Section 23: ARS 49-550-E (added...

Quality Improvement Efforts among Early Childhood Education Programs Participating in Iowa's Quality Rating System. REL 2017-244

ERIC Educational Resources Information Center

Hawkinson, Laura E.; Faria, Ann-Marie; Bouacha, Nora; Lee, Dong Hoon; Metzger, Ivan

2017-01-01

This report describes the quality improvement efforts of early childhood education programs participating in Iowa's Quality Rating System (QRS). It identifies supports and barriers to quality improvement and examines how quality improvement supports and activities relate to changes in program quality ratings across time. The study team developed…

Model of turnover kinetics in the lamellipodium: implications of slow- and fast- diffusing capping protein and Arp2/3 complex

NASA Astrophysics Data System (ADS)

McMillen, Laura M.; Vavylonis, Dimitrios

2016-12-01

Cell protrusion through polymerization of actin filaments at the leading edge of motile cells may be influenced by spatial gradients of diffuse actin and regulators. Here we study the distribution of two of the most important regulators, capping protein and Arp2/3 complex, which regulate actin polymerization in the lamellipodium through capping and nucleation of free barbed ends. We modeled their kinetics using data from prior single molecule microscopy experiments on XTC cells. These experiments have provided evidence for a broad distribution of diffusion coefficients of both capping protein and Arp2/3 complex. The slowly diffusing proteins appear as extended ‘clouds’ while proteins bound to the actin filament network appear as speckles that undergo retrograde flow. Speckle appearance and disappearance events correspond to assembly and dissociation from the actin filament network and speckle lifetimes correspond to the dissociation rate. The slowly diffusing capping protein could represent severed capped actin filament fragments or membrane-bound capping protein. Prior evidence suggests that slowly diffusing Apr2/3 complex associates with the membrane. We use the measured rates and estimates of diffusion coefficients of capping protein and Arp2/3 complex in a Monte Carlo simulation that includes particles in association with a filament network and diffuse in the cytoplasm. We consider two separate pools of diffuse proteins, representing fast and slowly diffusing species. We find a steady state with concentration gradients involving a balance of diffusive flow of fast and slow species with retrograde flow. We show that simulations of FRAP are consistent with prior experiments performed on different cell types. We provide estimates for the ratio of bound to diffuse complexes and calculate conditions where Arp2/3 complex recycling by diffusion may become limiting. We discuss the implications of slowly diffusing populations and suggest experiments to distinguish among mechanisms that influence long range transport.

Ringwoodite rim around olivine core in shock-induced melt veins of Antarctic chondrite : Mechanisms of transformation and Fe-Mg diffusion

NASA Astrophysics Data System (ADS)

Xie, Z.; Li, X.; Sharp, T. G.; de Carli, P. S.

2009-12-01

Introduction: High-pressure minerals, produced by shock metamorphism, are common in and around melt veins in highly shocked chondrites. The shock duration can be constrained by using transformation kinetics, such as the crystallization rate of the melt-vein matrix[1-2], or growth rate of the high-pressure minerals [3-4], or using elements diffusion rate between two minerals [5]. Using transformation kinetics to constrain shock duration de-pend on the details of the transformation mechanism. For example, growth of topotaxial ringwoodite in olivine with coherent interfaces is slower than growth of inclusions with incoherent interfaces [4-5]. Similarly, diffusion-controlled growth, where rates are determined by long-range diffusion, is generally much slower than interface-controlled growth, which is only dependent on diffusion across the interface [6-8]. The occurrences of the high-pressure mineral rims were recently reported in shock-induced melt veins in several heavily shocked (S6) chondrites, ALH78003, Peace River and GRV052049 [9-11]. Here we report EMAP and Raman results of the ringwoodite rims around olivine cores in shock veins of the Antarctic chondrites GRV 022321, and to elucidate the mechanisms of transformation and Mg-Fe diffusion of the olivine to ringwoodite. Results: GRV022321 has a network of black veins which enclose abundant host-rock fragments. The enclosed fragments have sizes ranging from 5 µm to 30 µm, with a brighter rim up to several µm wide and a dark core in reflected light and BSE image. The Raman data reveal that the rim mineral is ringwoodite signature, and the core minerals are dominated by olivine and mixed minor ringwoodite. EMAP data confirm that the ringwoodite in rim is richer in faylite (Fa) than the olivine core. The Fa values range from 50 to 10 with the outer rim having highest Fa value, and the inside darker area with a lower value. Discussion: The occurrence of the rounded shape grains with smooth edges embedded in the fine matrix in shock-induced melt veins suggest that they are enclosed host-rock fragments and that the ringwoodite in the rim was transformed by solid-state transformation from previous olivine. The variable extent of transformation is likely a result of temperature variations during shock, with the hottest outer olivine forming the ringwoodite rim. The outer hotter ringwoodite attract more Fe than inside cooler olivine, and Mg-Fe diffusion occurs in rapid transformation at high pressure and temperature over up to 10 µm distance. The sample is unique because we can test and double check different shock duration constraints in future work. References: [1] Langenhorst and Poirier (2000) EPSL 184, 37-55. [2] Xie, Z. et al. (2006) GCA, 70. 504-515. [3] Ohtani et al. (2004) EPSL 227(3-4), 505-515. [4] Xie and Sharp (2007), EPLS, 433-445. [5] Beck, et al. (2005) Nature 435, 1071-1074. [6] Kerschhofer et al. (1996) Science 274 (5284), 79-81. [7] Kerschhofer et al. (2000) PEPI 121, 59-76. [8] Sharp and DeCarli (2006) MESS II, 653-677. [9] Ohtani et al. (2006), Shock Waves, 16:45-52. [10] Miyahara et al. (2008) Proceedings. of NAS 105,8542-8547. [11] Feng et al. (2007), MAPS 42, A45.

Hyperthermal (1-100 eV) nitrogen ion scattering damage to D-ribose and 2-deoxy-D-ribose films

DOE Office of Scientific and Technical Information (OSTI.GOV)

Deng Zongwu; Bald, Ilko; Illenberger, Eugen

2007-10-14

Highly charged heavy ion traversal of a biological medium can produce energetic secondary fragment ions. These fragment ions can in turn cause collisional and reactive scattering damage to DNA. Here we report hyperthermal (1-100 eV) scattering of one such fragment ion (N{sup +}) from biologically relevant sugar molecules D-ribose and 2-deoxy-D-ribose condensed on polycrystalline Pt substrate. The results indicate that N{sup +} ion scattering at kinetic energies down to 10 eV induces effective decomposition of both sugar molecules and leads to the desorption of abundant cation and anion fragments. Use of isotope-labeled molecules (5-{sup 13}C D-ribose and 1-D D-ribose) partlymore » reveals some site specificity of the fragment origin. Several scattering reactions are also observed. Both ionic and neutral nitrogen atoms abstract carbon from the molecules to form CN{sup -} anion at energies down to {approx}5 eV. N{sup +} ions also abstract hydrogen from hydroxyl groups of the molecules to form NH{sup -} and NH{sub 2}{sup -} anions. A fraction of O/O{sup -} fragments abstract hydrogen to form OH{sup -}. The formation of H{sub 3}O{sup +} ions also involves hydrogen abstraction as well as intramolecular proton transfer. These findings suggest a variety of severe damaging pathways to DNA molecules which occur on the picosecond time scale following heavy ion irradiation of a cell, and prior to the late diffusion-limited homogeneous chemical processes.« less

Peptide dynamics by molecular dynamics simulation and diffusion theory method with improved basis sets

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hsu, Po Jen; Lai, S. K., E-mail: sklai@coll.phy.ncu.edu.tw; Rapallo, Arnaldo

Improved basis sets for the study of polymer dynamics by means of the diffusion theory, and tests on a melt of cis-1,4-polyisoprene decamers, and a toluene solution of a 71-mer syndiotactic trans-1,2-polypentadiene were presented recently [R. Gaspari and A. Rapallo, J. Chem. Phys. 128, 244109 (2008)]. The proposed hybrid basis approach (HBA) combined two techniques, the long time sorting procedure and the maximum correlation approximation. The HBA takes advantage of the strength of these two techniques, and its basis sets proved to be very effective and computationally convenient in describing both local and global dynamics in cases of flexible syntheticmore » polymers where the repeating unit is a unique type of monomer. The question then arises if the same efficacy continues when the HBA is applied to polymers of different monomers, variable local stiffness along the chain and with longer persistence length, which have different local and global dynamical properties against the above-mentioned systems. Important examples of this kind of molecular chains are the proteins, so that a fragment of the protein transthyretin is chosen as the system of the present study. This peptide corresponds to a sequence that is structured in β-sheets of the protein and is located on the surface of the channel with thyroxin. The protein transthyretin forms amyloid fibrils in vivo, whereas the peptide fragment has been shown [C. P. Jaroniec, C. E. MacPhee, N. S. Astrof, C. M. Dobson, and R. G. Griffin, Proc. Natl. Acad. Sci. U.S.A. 99, 16748 (2002)] to form amyloid fibrils in vitro in extended β-sheet conformations. For these reasons the latter is given considerable attention in the literature and studied also as an isolated fragment in water solution where both experimental and theoretical efforts have indicated the propensity of the system to form β turns or α helices, but is otherwise predominantly unstructured. Differing from previous computational studies that employed implicit solvent, we performed in this work the classical molecular dynamics simulation on a realistic model solution with the peptide embedded in an explicit water environment, and calculated its dynamic properties both as an outcome of the simulations, and by the diffusion theory in reduced statistical-mechanical approach within HBA on the premise that the mode-coupling approach to the diffusion theory can give both the long-range and local dynamics starting from equilibrium averages which were obtained from detailed atomistic simulations.« less

Continental tectonics in the aftermath of plate tectonics

NASA Technical Reports Server (NTRS)

Molnar, Peter

1988-01-01

It is shown that the basic tenet of plate tectonics, rigid-body movements of large plates of lithosphere, fails to apply to continental interiors. There, buoyant continental crust can detach from the underlying mantle to form mountain ranges and broad zones of diffuse tectonic activity. The role of crustal blocks and of the detachment of crustal fragments in this process is discussed. Future areas of investigation are addressed.

Metal Ion Sensor with Catalytic DNA in a Nanofluidic Intelligent Processor

DTIC Science & Technology

2011-12-01

attributed to decreased diffusion and less active DNAzyme complex because of pore constraints. Uncleavable Alexa546 intensity is shown in gray ...is shown in gray , cleavable fluorescein in green, and the ratio of Fl/Alexa in red. Error bars represent one standard deviation of four independent...higher concentrations inhibiting cleaved fragment release. Uncleavable Alexa 546 intensity is shown in gray , cleavable fluorescein in green, and the

Neutron density distributions of neutron-rich nuclei studied with the isobaric yield ratio difference

NASA Astrophysics Data System (ADS)

Ma, Chun-Wang; Bai, Xiao-Man; Yu, Jiao; Wei, Hui-Ling

2014-09-01

The isobaric yield ratio difference (IBD) between two reactions of similar experimental setups is found to be sensitive to nuclear density differences between projectiles. In this article, the IBD probe is used to study the density variation in neutron-rich 48Ca . By adjusting diffuseness in the neutron density distribution, three different neutron density distributions of 48Ca are obtained. The yields of fragments in the 80 A MeV 40, 48Ca + 12C reactions are calculated by using a modified statistical abrasion-ablation model. It is found that the IBD results obtained from the prefragments are sensitive to the density distribution of the projectile, while the IBD results from the final fragments are less sensitive to the density distribution of the projectile.

Universal shape evolution of particles by bed-load

NASA Astrophysics Data System (ADS)

Jerolmack, D. J.; Domokos, G.; Shaw, S.; Sipos, A.; Szabo, T.

2016-12-01

River currents, wind and waves drive bed-load transport, in which sediment particles collide with each other and the Earth's surface. A generic consequence is erosion and rounding of particles as a result of chipping, often referred to in geological literature as abrasion. Recent studies have shown that the erosion of river pebbles can be modeled as diffusion of surface curvature, indicating that geometric aspects of chipping erosion are insensitive to details of collisions and material properties. Here we present data from fluvial, aeolian and coastal environments that suggest a universal relation between particle circularity and mass lost due to bed-load chipping. Simulations and experiments support the diffusion model and demonstrate that three constraints are required to produce this universal curve: (i) initial particles are fragments; (ii) erosion is dominated by collisions among like-sized particles; and (iii) collision energy is small enough that chipping dominates over fragmentation. We show that the mechanics of bedrock weathering and bed-load transport select these constraints, providing the foundation to estimate a particle's erosion rate from its shape alone in most sedimentary environments. These findings may be used to determine the contribution of chipping to downstream fining in rivers and deserts, and to infer transport conditions using only images of sediment grains.

Sortilin Fragments Deposit at Senile Plaques in Human Cerebrum

PubMed Central

Hu, Xia; Hu, Zhao-Lan; Li, Zheng; Ruan, Chun-Sheng; Qiu, Wen-Ying; Pan, Aihua; Li, Chang-Qi; Cai, Yan; Shen, Lu; Chu, Yaping; Tang, Bei-Sha; Cai, Huaibin; Zhou, Xin-Fu; Ma, Chao; Yan, Xiao-Xin

2017-01-01

Genetic variations in the vacuolar protein sorting 10 protein (Vps10p) family have been linked to Alzheimer’s disease (AD). Here we demonstrate deposition of fragments from the Vps10p member sortilin at senile plaques (SPs) in aged and AD human cerebrum. Sortilin changes were characterized in postmortem brains with antibodies against the extracellular and intracellular C-terminal domains. The two antibodies exhibited identical labeling in normal human cerebrum, occurring in the somata and dendrites of cortical and hippocampal neurons. The C-terminal antibody also marked extracellular lesions in some aged and all AD cases, appearing as isolated fibrils, mini-plaques, dense-packing or circular mature-looking plaques. Sortilin and β-amyloid (Aβ) deposition were correlated overtly in a region/lamina- and case-dependent manner as analyzed in the temporal lobe structures, with co-localized immunofluorescence seen at individual SPs. However, sortilin deposition rarely occurred around the pia, at vascular wall or in areas with typical diffuse Aβ deposition, with the labeling not enhanced by section pretreatment with heating or formic acid. Levels of a major sortilin fragment ~15 kDa, predicted to derive from the C-terminal region, were dramatically elevated in AD relative to control cortical lysates. Thus, sortilin fragments are a prominent constituent of the extracellularly deposited protein products at SPs in human cerebrum. PMID:28638323

The Role of Surface Passivation in Controlling Ge Nanowire Faceting.

PubMed

Gamalski, A D; Tersoff, J; Kodambaka, S; Zakharov, D N; Ross, F M; Stach, E A

2015-12-09

In situ transmission electron microscopy observations of nanowire morphologies indicate that during Au-catalyzed Ge nanowire growth, Ge facets can rapidly form along the nanowire sidewalls when the source gas (here, digermane) flux is decreased or the temperature is increased. This sidewall faceting is accompanied by continuous catalyst loss as Au diffuses from the droplet to the wire surface. We suggest that high digermane flux and low temperatures promote effective surface passivation of Ge nanowires with H or other digermane fragments inhibiting diffusion and attachment of Au and Ge on the sidewalls. These results illustrate the essential roles of the precursor gas and substrate temperature in maintaining nanowire sidewall passivation, necessary to ensure the growth of straight, untapered, ⟨111⟩-oriented nanowires.

11. Photocopy of architectural drawing (from National Archives Architectural and ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

11. Photocopy of architectural drawing (from National Archives Architectural and Cartographic Branch Alexandria, Va.) 'Non-Com-Officers Qrs.' Quartermaster General's Office Standard Plan 82, sheet 1. Lithograph on linen architectural drawing. April 1893 3 ELEVATIONS, 3 PLANS AND A PARTIAL SECTION - Fort Myer, Non-Commissioned Officers Quarters, Washington Avenue between Johnson Lane & Custer Road, Arlington, Arlington County, VA

9. Photocopy of architectural drawing (from blueprint at Fort Myer ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

9. Photocopy of architectural drawing (from blueprint at Fort Myer Engineer Activity) 'Double Set of Non-Commissioned Officers Qrs.' Quartermaster Generals Office, sheet 1 and unnumbered sheet, standard plan 23, June 1891. lithograph on linen architectural drawing 2. PLANS, 1 SECTION, 2 DETAILS - Fort Myer, Non-Commissioned Officers Quarters, Washington Avenue between Johnson Lane & Custer Road, Arlington, Arlington County, VA

Research and development of the device for diagnostics of arrhythmia

NASA Astrophysics Data System (ADS)

Lezhnina, I. A.; Boyakhchyan, A. A.; Overchuk, K. V.; Uvarov, A. A.

2017-08-01

The article describes the results of the research for sensors optimal arrangement during one limb ECG detection. The found placement provides the registration of the enough quality signal sufficient for the diagnosis of arrhythmia, the QRS complex is clearly recognized. Authors also show the test results of the device developed for the diagnosis of arrhythmia and sudden cardiac death.

Photovoltaic properties of multilayered quantum dot/quantum rod-sensitized TiO₂ solar cells fabricated by SILAR and electrophoresis.

PubMed

Cerdán-Pasarán, Andrea; López-Luke, Tzarara; Esparza, Diego; Zarazúa, Isaac; De la Rosa, Elder; Fuentes-Ramírez, Rosalba; Alatorre-Ordaz, Alejandro; Sánchez-Solís, Ana; Torres-Castro, Alejandro; Zhang, Jin Z

2015-07-28

A multilayered semiconductor sensitizer structure composed of three differently sized CdSe quantum rods (QRs), labeled as Q530, Q575, Q590, were prepared and deposited on the surface of mesoporous TiO2 nanoparticles by electrophoretic deposition (EPD) for photovoltaic applications. By varying the arrangement of layers as well as the time of EPD, the photoconversion efficiency was improved from 2.0% with the single layer of CdSe QRs (TiO2/Q590/ZnS) to 2.9% for multilayers (TiO2/Q590Q575/ZnS). The optimal EPD time was shorter for the multilayered structures. The effect of CdS quantum dots (QDs) deposited by successive ionic layer adsorption and reaction (SILAR) was also investigated. The addition of CdS QDs resulted in the enhancement of efficiency to 4.1% for the configuration (TiO2/CdS/Q590Q575/ZnS), due to increased photocurrent and photovoltage. Based on detailed structural, optical, and photoelectrical studies, the increased photocurrent is attributed to broadened light absorption while the increased voltage is due to a shift in the relevant energy levels.

A method for the automatic reconstruction of fetal cardiac signals from magnetocardiographic recordings

NASA Astrophysics Data System (ADS)

Mantini, D.; Alleva, G.; Comani, S.

2005-10-01

Fetal magnetocardiography (fMCG) allows monitoring the fetal heart function through algorithms able to retrieve the fetal cardiac signal, but no standardized automatic model has become available so far. In this paper, we describe an automatic method that restores the fetal cardiac trace from fMCG recordings by means of a weighted summation of fetal components separated with independent component analysis (ICA) and identified through dedicated algorithms that analyse the frequency content and temporal structure of each source signal. Multichannel fMCG datasets of 66 healthy and 4 arrhythmic fetuses were used to validate the automatic method with respect to a classical procedure requiring the manual classification of fetal components by an expert investigator. ICA was run with input clusters of different dimensions to simulate various MCG systems. Detection rates, true negative and false positive component categorization, QRS amplitude, standard deviation and signal-to-noise ratio of reconstructed fetal signals, and real and per cent QRS differences between paired fetal traces retrieved automatically and manually were calculated to quantify the performances of the automatic method. Its robustness and reliability, particularly evident with the use of large input clusters, might increase the diagnostic role of fMCG during the prenatal period.

Electocardiographic findings in adult Nigerians with sickle cell anaemia.

PubMed

Oguanobi, N I; Onwubere, B J C; Ike, S O; Anisiuba, B C; Ejim, E C; Ibegbulam, O G

2010-09-01

Cardiovascular system abnormalities are common causes of morbidity and mortality in sickle cell anaemia. The study aims at determining the pattern of electrocardiographic changes in adult Nigerian sickle cell anaemia patients. A descriptive cross sectional study was done on sixty sickle cell anaemia patients seen at the adult sickle cell clinic of University of Nigeria Teaching Hospital (UNTH) Enugu, and sixty age and sex matched normal controls. All the subjects had clinical evaluation as well as electrocardiographic examination. The mean heart rate, P-wave duration, P-wave dispersion, PR interval, QRS duration, QRS dispersion, QTc interval and QTc dispersion were significantly higher in the patients than in the control group. Electrocardiographic abnormalities identified by this study were: left ventricular hypertrophy (75%; 1.7%), left atrial enlargement (40%; 0%), biventricular hypertrophy (11%; 0), ST-segment elevation (10%; 0%) and increased P-wave and QTc dispersions. ST segment elevation was found more in patients with moderate and severe anaemia (P= 0.02, Spearman correlation r= 0.342; P= 0.007), Sickle cell anaemia is associated with significant electrocardiographic abnormalities. Further prospective studies are recommended to evaluate the prognostic significance of the electrocardiographic intervals dispersion on the long term disease outcome in sickle cell anaemia.

Is speckle tracking actually helpful for cardiac resynchronization therapy?

PubMed

Tanaka, Hidekazu; Hirata, Ken-Ichi

2016-06-01

What is the specific role of echocardiography in cardiac resynchronization therapy (CRT)? CRT has proven to be highly effective for improving symptoms and survival of patients with advanced heart failure (HF) and wide QRS. However, a significant minority of patients do not respond favorably to CRT on the basis of standard clinical selection criteria, including the electrocardiographic QRS width. Subsequently, echocardiographic assessment of left ventricular (LV) dyssynchrony has been considered useful for CRT for selected responders, but findings by multicenter studies suggest that its predictive value was not sufficiently robust to replace routine selection criteria for CRT. A more recent approach, however, using speckle-tracking echocardiography yields more accurate quantification of regional wall contraction. Speckle-tracking approaches have therefore generated a great deal of interest about their clinical applications for CRT. Although reports on speckle tracking have not been included in any recommendations as to whether patients should undergo CRT based on the current guidelines, speckle tracking can play an important supplementary part in CRT on the basis of a case-by-case clinical decision for challenging cases. Here, we review the strengths of speckle-tracking methods, and their current potential for clinical use in CRT.

Identification of a Sudden Cardiac Death Susceptibility Locus at 2q24.2 through Genome-Wide Association in European Ancestry Individuals

PubMed Central

Reinier, Kyndaron; Teodorescu, Carmen; Uy-Evanado, Audrey; Carter-Monroe, Naima; Kaikkonen, Kari S.; Kortelainen, Marja-Leena; Boucher, Gabrielle; Lagacé, Caroline; Moes, Anna; Zhao, XiaoQing; Kolodgie, Frank; Rivadeneira, Fernando; Hofman, Albert; Witteman, Jacqueline C. M.; Uitterlinden, André G.; Marsman, Roos F.; Pazoki, Raha; Bardai, Abdennasser; Koster, Rudolph W.; Dehghan, Abbas; Hwang, Shih-Jen; Bhatnagar, Pallav; Post, Wendy; Hilton, Gina; Prineas, Ronald J.; Li, Man; Köttgen, Anna; Ehret, Georg; Boerwinkle, Eric; Coresh, Josef; Kao, W. H. Linda; Psaty, Bruce M.; Tomaselli, Gordon F.; Sotoodehnia, Nona; Siscovick, David S.; Burke, Greg L.; Marbán, Eduardo; Spooner, Peter M.; Cupples, L. Adrienne; Jui, Jonathan; Gunson, Karen; Kesäniemi, Y. Antero; Wilde, Arthur A. M.; Tardif, Jean-Claude; O'Donnell, Christopher J.; Bezzina, Connie R.; Virmani, Renu; Stricker, Bruno H. C. h.; Tan, Hanno L.; Albert, Christine M.; Chakravarti, Aravinda; Rioux, John D.; Huikuri, Heikki V.; Chugh, Sumeet S.

2011-01-01

Sudden cardiac death (SCD) continues to be one of the leading causes of mortality worldwide, with an annual incidence estimated at 250,000–300,000 in the United States and with the vast majority occurring in the setting of coronary disease. We performed a genome-wide association meta-analysis in 1,283 SCD cases and >20,000 control individuals of European ancestry from 5 studies, with follow-up genotyping in up to 3,119 SCD cases and 11,146 controls from 11 European ancestry studies, and identify the BAZ2B locus as associated with SCD (P = 1.8×10−10). The risk allele, while ancestral, has a frequency of ∼1.4%, suggesting strong negative selection and increases risk for SCD by 1.92–fold per allele (95% CI 1.57–2.34). We also tested the role of 49 SNPs previously implicated in modulating electrocardiographic traits (QRS, QT, and RR intervals). Consistent with epidemiological studies showing increased risk of SCD with prolonged QRS/QT intervals, the interval-prolonging alleles are in aggregate associated with increased risk for SCD (P = 0.006). PMID:21738491

Mechanical Dyssynchrony Precedes QRS Widening in ATP‐Sensitive K+ Channel–Deficient Dilated Cardiomyopathy

PubMed Central

Yamada, Satsuki; Arrell, D. Kent; Kane, Garvan C.; Nelson, Timothy J.; Perez‐Terzic, Carmen M.; Behfar, Atta; Purushothaman, Saranya; Prinzen, Frits W.; Auricchio, Angelo; Terzic, Andre

2013-01-01

Background Contractile discordance exacerbates cardiac dysfunction, aggravating heart failure outcome. Dissecting the genesis of mechanical dyssynchrony would enable an early diagnosis before advanced disease. Methods and Results High‐resolution speckle‐tracking echocardiography was applied in a knockout murine surrogate of adult‐onset human cardiomyopathy caused by mutations in cardioprotective ATP‐sensitive K+ (KATP) channels. Preceding the established criteria of cardiac dyssynchrony, multiparametric speckle‐based strain resolved nascent erosion of dysfunctional regions within cardiomyopathic ventricles of the KATP channel–null mutant exposed to hemodynamic stress. Not observed in wild‐type counterparts, intraventricular disparity in wall motion, validated by the degree, direction, and delay of myocardial speckle patterns, unmasked the disease substrate from asymptomatic to overt heart failure. Mechanical dyssynchrony preceded widening of the QRS complex and exercise intolerance and progressed into global myocardial discoordination and decompensated cardiac pump function, precipitating a low output syndrome. Conclusions The present study, with the use of high‐resolution imaging, prospectively resolved the origin and extent of intraventricular motion disparity in a KATP channel–knockout model of dilated cardiomyopathy. Mechanical dyssynchrony established as an early marker of cardiomyopathic disease offers novel insight into the pathodynamics of dyssynchronous heart failure. PMID:24308936

Lacosamide-Induced Recurrent Ventricular Tachycardia in the Acute Care Setting.

PubMed

Berei, Theodore J; Lillyblad, Matthew P; Almquist, Adrian K

2018-04-01

Lacosamide is a new-generation antiepileptic drug (AED) most commonly used adjunctively in the setting of partial-onset seizures refractory to traditional therapy. We describe the first case report, to our knowledge, of a patient who developed recurrent, sustained ventricular tachycardia with multiple administrations of lacosamide in an acute setting. A 70-year-old woman with a history significant for valvular heart disease was admitted to the inpatient cardiology service for worsening heart failure. On hospital day 7, she received a bioprosthetic aortic valve. Prior to surgery and immediately after, the patient's electrocardiogram (ECG) was normal. After developing multiple generalized tonic-clonic seizures refractory to levetiracetam, fosphenytoin, and valproic acid, the decision was made to initiate lacosamide. Two hours following the second lacosamide dose, the patient developed a wide complex QRS that transitioned into sustained ventricular tachycardia requiring electrical cardioversion. Sustained ventricular tachycardia occurred again, just hours after the third dose of lacosamide was given. Following cessation of lacosamide, the patient's QRS interval normalized and has since had no documented episodes of ventricular tachycardia. Clinicians should be aware of the potential for life-threatening rhythmic disturbances in patients initiated on lacosamide and the need for vigilant ECG, electrolyte, and drug-drug monitoring.

Atypical Findings in Massive Bupropion Overdose: A Case Report and Discussion of Psychopharmacologic Issues.

PubMed

Zhu, Yuanjia; Kolawole, Tiwalola; Jimenez, Xavier F

2016-09-01

Bupropion is an atypical antidepressant that is structurally similar to amphetamines. Its primary toxic effects include seizure, sinus tachycardia, hypertension, and agitation; however, at higher amounts of ingestion, paradoxical cardiac effects are seen. We report the case of a 21-year-old woman who ingested 13.5 g of bupropion, a dose higher than any other previously reported. The patient presented with seizure, sinus tachycardia with prolonged QTc and QRS intervals, dilated pupils, and agitation. Four days after overdose, the patient's sinus tachycardia and prolonged QTc and QRS intervals resolved with symptomatic management, but she soon developed sinus bradycardia, hypotension, and mild transaminitis. With continued conservative management and close monitoring, her sinus bradycardia resolved 8 days after the overdose. The transaminitis resolved 12 days after the overdose. Our findings are consistent with previously reported toxic effects associated with common overdose amounts of bupropion. In addition, we have observed transient cardiotoxicity manifesting as sinus bradycardia associated with massive bupropion overdose. These findings are less frequently reported and must be considered when managing patients with massive bupropion overdose. We review the psychopharmacologic implications of this and comment on previous literature.

Evaluation of heart rate variability indices using a real-time handheld remote ECG monitor.

PubMed

Singh, Swaroop S; Carlson, Barbara W; Hsiao, Henry S

2007-12-01

Studies on retrospective electrocardiogram (ECG) recordings of patients during cardiac arrest have shown significant changes in heart rate variability (HRV) indices prior to the onset of cardiac arrhythmia. The early detection of these changes in HRV indices increases the chances for a successful medical intervention by increasing the response time window. A portable, handheld remote ECG monitor designed in this research detects the QRS complex and calculates short-term HRV indices in real-time. The QRS detection of the ECG recordings of subjects from the MIT-Arrhythmia database yielded a mean sensitivity of 99.34% and a specificity of 99.31%. ECG recordings from normal subjects and subjects with congestive heart failure were used to identify the differences in HRV indices. An increase in heart rate, high-frequency spectral power (HFP), total spectral power, the ratio of HFP to low-frequency spectral power (LFP), and a decrease in root mean square sum of RR differences were observed. No difference was found on comparison of the standard deviation of normal to normal interval between adjacent R-waves, LFP, and very-low-frequency spectral power. Based on these, additional analytical calculations could be made to provide early warnings of impending cardiac conditions.

Early prediction of cardiac resynchronization therapy response by non-invasive electrocardiogram markers.

PubMed

Ortigosa, Nuria; Pérez-Roselló, Víctor; Donoso, Víctor; Osca, Joaquín; Martínez-Dolz, Luis; Fernández, Carmen; Galbis, Antonio

2018-04-01

Cardiac resynchronization therapy (CRT) is an effective treatment for those patients with severe heart failure. Regrettably, there are about one third of CRT "non-responders", i.e. patients who have undergone this form of device therapy but do not respond to it, which adversely affects the utility and cost-effectiveness of CRT. In this paper, we assess the ability of a novel surface ECG marker to predict CRT response. We performed a retrospective exploratory study of the ECG previous to CRT implantation in 43 consecutive patients with ischemic (17) or non-ischemic (26) cardiomyopathy. We extracted the QRST complexes (consisting of the QRS complex, the S-T segment, and the T wave) and obtained a measure of their energy by means of spectral analysis. This ECG marker showed statistically significant lower values for non-responder patients and, joint with the duration of QRS complexes (the current gold-standard to predict CRT response), the following performances: 86% accuracy, 88% sensitivity, and 80% specificity. In this manner, the proposed ECG marker may help clinicians to predict positive response to CRT in a non-invasive way, in order to minimize unsuccessful procedures.

Source identification of soil mercury in the Spanish islands.

PubMed

Rodríguez Martín, José Antonio; Carbonell, Gregoria; Nanos, Nikos; Gutiérrez, Carmen

2013-02-01

This study spatially analysed the relation between mercury (Hg) content in soil and Hg in rock fragment for the purpose of assessing natural soil Hg contribution compared with Hg from human inputs. We present the Hg content of 318 soil and rock fragment samples from 11 islands distributed into two Spanish archipelagos (the volcanic Canary Islands [Canaries] and the Mediterranean Balearic [Balearic] islands). Assumedly both are located far enough away from continental Hg sources to be able to minimise the effects of diffuse pollution. Physical and chemical soil properties were also specified for the samples. Hg contents were significantly greater in the Balearic limestone soils (61 μg kg(-1)) than in the volcanic soils of the Canaries (33 μg kg(-1)). Hg levels were also greater in topsoil than in rocky fragments, especially on the Balearics. The soil-to-rock ratios varied between 1 and 30. Interestingly, the highest topsoil-to-rock Hg ratio (>16 ×) was found in the vicinity of a coal-fired power plant in Majorca, whereas no similar areas in the Canary archipelago were identified.

Protein interactions with subcutaneously implanted biosensors.

PubMed

Gifford, Raeann; Kehoe, Joseph J; Barnes, Sandra L; Kornilayev, Boris A; Alterman, Michail A; Wilson, George S

2006-04-01

Biofouling of in vivo glucose sensors has been indicated as the primary reason for sensitivity losses observed during the first 24 h after implant [Wisniewski N, Moussy F, Reichert WM. Characterization of implantable biosensor membrane biofouling. Fresen J Anal Chem 2000; 366(6-7): 611-621]. Identification of the biomolecules that contribute to these sensitivity perturbations is the primary objective of the research presented. Active needle-type glucose sensors were implanted in Sprague-Dawley rats for 24h, and then a proteomics approach was used to identify the substances absorbed to the sensors. MALDI-TOF mass spectrometry was the primary tool utilized to identify the biomolecules in sensor leachate samples and species absorbed directly on sensor membranes excised from explanted in vivo sensors. Not surprisingly serum albumin was identified as the primary biomolecule present, however, predominantly as endogenous fragments of the protein. In addition, several other biomolecule fragments, mainly less than 15 kD, were identified. Based on these findings, it is concluded that fragments of larger biomolecules infiltrate the sensor membranes causing diminished glucose diffusivity, thus decreasing in vivo sensitivity.

Identification and cloning of a type III polyketide synthase required for diffusible pigment biosynthesis in Saccharopolyspora erythraea.

PubMed

Cortés, Jesús; Velasco, Javier; Foster, Graham; Blackaby, Andrew P; Rudd, Brian A M; Wilkinson, Barrie

2002-06-01

The soluble, diffusible red-brown pigment produced by a Saccharopolyspora erythraea "red variant" has been shown to contain glycosylated and polymerized derivatives of 2,5,7-trihydroxy-1,4-naphthoquinone (flaviolin). Flaviolin is a spontaneous oxidation product of 1,3,6,8-tetrahydroxynaphthalene (THN), which is biosynthesized in bacteria by a chalcone synthase-like (CS-like) type III polyketide synthase (PKS). A fragment of the gene responsible for THN biosynthesis in S. erythraea E_8-7 was amplified by polymerase chain reaction (PCR) using degenerate primers based on conserved regions of known plant CS and bacterial CS-like genes. From the isolated fragment, a suicide vector was prepared, which was subsequently used to disrupt the red-brown pigment-producing (rpp) locus in S. erythraea, generating a mutant that displayed an albino phenotype. Chromosomal DNA from the albino mutant was subsequently used in a vector-recapture protocol to isolate a plasmid that contained an insert spanning the entire rpp locus. Sequencing of the insert revealed that the disrupted open reading frame (ORF) encodes a CS-like protein displaying 69% sequence identity to the rppA gene of Streptomyces griseus. The S. griseus rppA gene encodes RppA, the first characterized bacterial CS-like protein, which is sufficient in vitro for the synthesis of THN from malonyl-CoA. The rppA disruption mutant and rppA sequence provided a means by which to address the mechanism of diffusible pigment biosynthesis, as well as to investigate any link between this and the modulation of erythromycin A titre, which has been observed for S. erythraea variants.

The Thermoregulatory Function of Thatched Nests in the South American Grass-Cutting Ant, Acromyrmex heyeri

PubMed Central

Bollazzi, Martin; Roces, Flavio

2010-01-01

The construction of mound-shaped nests by ants is considered as a behavioral adaptation to low environmental temperatures, i.e., colonies achieve higher and more stables temperatures than those of the environment. Besides the well-known nests of boreal Formica wood-ants, several species of South American leaf-cutting ants of the genus Acromyrmex construct thatched nests. Acromyrmex workers import plant fragments as building material, and arrange them so as to form a thatch covering a central chamber, where the fungus garden is located. Thus, the degree of thermoregulation attained by the fungus garden inside the thatched nest largely depends on how the thatch affects the thermal relations between the fungus and the environment. This work was aimed at studying the thermoregulatory function of the thatched nests built by the grass-cutting ant Acromyrmex heyeri Forel (Hymenoptera: Formicidae: Myrmicinae). Nest and environmental temperatures were measured as a function of solar radiation on the long-term. The thermal diffusivity of the nest thatch was measured and compared to that of the surrounding soil, in order to assess the influence of the building material on the nest's thermoregulatory ability. The results showed that the average core temperature of thatched nests was higher than that of the environment, but remained below values harmful for the fungus. This thermoregulation was brought about by the low thermal diffusivity of the nest thatch built by workers with plant fragments, instead of the readily-available soil particles that have a higher thermal diffusivity. The thatch prevented diurnal nest overheating by the incoming solar radiation, and avoided losses of the accumulated daily heat into the cold air during the night. The adaptive value of thatching behavior in Acromyrmex leaf-cutting ants occurring in the southernmost distribution range is discussed. PMID:20883129

Cardiac Repolarization Abnormalities and Potential Evidence for Loss of Cardiac Sodium Currents on ECGs of Patients with Chagas' Heart Disease

NASA Technical Reports Server (NTRS)

Schlegel, T. T.; Medina, R.; Jugo, D.; Nunez, T. J.; Borrego, A.; Arellano, E.; Arenare, B.; DePalma, J. L.; Greco, E. C.; Starc, V.

2007-01-01

Some individuals with Chagas disease develop right precordial lead ST segment elevation in response to an ajmaline challenge test, and the prevalence of right bundle branch block (RBBB) is also high in Chagas disease. Because these same electrocardiographic abnormalities occur in the Brugada syndrome, which involves genetically defective cardiac sodium channels, acquired damage to cardiac sodium channels may also occur in Chagas disease. We studied several conventional and advanced resting 12-lead/derived Frank-lead ECG parameters in 34 patients with Chagas -related heart disease (mean age 39 14 years) and in 34 age-/gender-matched healthy controls. All ECG recordings were of 5-10 min duration, obtained in the supine position using high fidelity hardware/software (CardioSoft, Houston, TX). Even after excluding those Chagas patients who had resting BBBs, tachycardia and/or pathologic arrhythmia (n=8), significant differences remained in multiple conventional and advanced ECG parameters between the Chagas and control groups (n=26/group), especially in their respective QT interval variability indices, maximal spatial QRS-T angles and low frequency HRV powers (p=0.0006, p=0.0015 and p=0.0314 respectively). In relation to the issue of potential damage to cardiac sodium channels, the Chagas patients had: 1) greater than or equal to twice the incidence of resting ST segment elevation in leads V1-V3 (n=10/26 vs. n=5/26) and of both leftward (n=5/26 versus n=0/26) and rightward (n=7/26 versus n=3/26) QRS axis deviation than controls; 2) significantly increased filtered (40-250 Hz) QRS interval durations (92.1 8.5 versus 85.3 plus or minus 9.0 ms, p=0.022) versus controls; and 3) significantly decreased QT and especially JT interval durations versus controls (QT interval: 387.5 plus or minus 26.4 versus 408.9 plus or minus 34.6 ms, p=0.013; JT interval: 290.5 plus or minus 26.3 versus 314.8 plus or minus 31.3 ms; p=0.0029). Heart rates and Bazett-corrected QTc/JTc intervals were not significantly different between groups. Patients with Chagas heart disease have increased cardiac repolarization abnormalities, especially by advanced ECG. Moreover, as a group, they have decreased uncorrected JT and QT interval durations and increased filtered QRS interval durations (versus age/gender-matched controls), all suggesting a potential loss of cardiac sodium channel function that might be mediated, in part, by cardiac autonomic damage. Overall findings support Brugada et al's recent hypothesis that the pathway leading to sudden death may often be similar in Chagas' disease and Brugada syndrome i.e., damage to the sodium channel (infectious/immunologic/autonomic in Chagas' genetic in Brugada) with consequent loss of sodium currents may facilitate a phase II-reentry based arrhythmic substrate for ventricular fibrillation in both conditions. In general, JT interval-related results have been underreported in the Chagas literature.

A comprehensive model of ion diffusion and charge exchange in the cold Io torus

NASA Technical Reports Server (NTRS)

Barbosa, D. D.; Moreno, M. A.

1988-01-01

A comprehensive analytic model of radial diffusion in the cold Io torus is developed. The model involves a generalized molecular cloud theory of SO2 and its dissociation fragments SO, O2, S, and O, which are formed at a relatively large rate by solar UV photodissociation of SO2. The key component of the new theory is SO, which can react with S(+) through a near-resonant charge exchange process that is exothermic. This provides a mechanism for the rapid depletion of singly ionized sulfur in the cold torus and can account for the large decrease in the total flux tube content inward of Io's orbit. The model is used to demonstrate quantitatively the effects of radial diffusion in a charge exchange environment that acts as a combined source and sink for ions in various charge states. A detailed quantitative explanation for the O(2+) component of the cold torus is given, and insight is derived into the workings of the so-called plasma 'ribbon'.

Conodont (U Th)/He thermochronology: Initial results, potential, and problems

NASA Astrophysics Data System (ADS)

Peppe, Daniel J.; Reiners, Peter W.

2007-06-01

We performed He diffusion experiments and (U-Th)/He age determinations on conodonts from a variety of locations to explore the potential of conodont (U-Th)/He thermochronology to constrain thermal and exhumation histories of some sedimentary-rock dominated terrains. Based on two diffusion experiments and age results from some specimens, He diffusion in conodont elements appears to be similar to that in Durango apatite fragments of similar size, and closure temperatures are approximately 60-70 °C (for cooling rates of ˜ 10 °C/m.y.). (U-Th)/He ages of conodonts from some locations yield reproducible ages consistent with regional thermal history constraints and, in at least two cases, require a closure temperature lower than ˜ 80 °C. Other samples however, yield irreproducible ages, and in one case yield ages much younger than expected based on regional geologic considerations. These irreproducible samples show inverse correlations between parent nuclides and age consistent with late-stage open-system U-Th behavior.

A Comparative Study of Stress Profiles in Mothers of Children with Autism and Those of Children with Down's Syndrome

ERIC Educational Resources Information Center

Pisula, Ewa

2007-01-01

Background: The purpose of the present study was to determine the stress in mothers whose children have autism and to compare it with the stress in mothers whose children have Down's syndrome. Method: Fifty mothers whose children had autism (n = 25) or Down's syndrome (n = 25) completed the Questionnaire on Resources and Stress (QRS) and answered…

Changes in parameters of right ventricular function with cardiac resynchronization therapy.

PubMed

Sharma, Abhishek; Lavie, Carl J; Vallakati, Ajay; Garg, Akash; Goel, Sunny; Lazar, Jason; Fonarow, Gregg C

2017-11-01

Studies have shown that cardiac resynchronization therapy (CRT) significantly improves right ventricle (RV) size and function in patients with heart failure (HF). CRT does not lead to improvement in RV function independent of baseline clinical variables. A systematic search of studies published between 1966 to August 31, 2015 was conducted using Pub Med, CINAHL, Cochrane CENTRAL and the Web of Science databases. Studies reporting tricuspid annular plane systolic excursion (TAPSE) or RV basal strain or RV long axis diameter or RV short axis diameter or RV fractional area change (FAC), before and after CRT, were identified. A meta-analysis was performed using random effects with inverse variance method to determine the pooled mean difference in various parameters of RV function after CRT. Meta-regression analysis was performed to test the relationship between change in various parameters of RV functions after CRT and covariates- age, QRS duration, and left ventricular ejection fraction (LVEF). Thirteen studies (N=1541) were selected for final analysis. CRT therapy led to statistically significant increases in TAPSE [1.21 (95% CI 0.55-1.86; p<0.001)], RV FAC [2.26 (95% CI 0.50-4.01; p<0.001)] and basal strain [2.82 (95% CI 0.59-5.05; p<0.001)] and statistically significant decreases in mean RV long axis diameter [-2.94 (95% CI -5.07- -0.82; p=0.005)] and short axis diameter [-1.39 (95% CI -2.10- -0.67; p=0.876)] after a mean follow up period of 9 months. However, after meta-regression analysis for age, QRS duration, and baseline LVEF as covariates, there was no significant improvement in any of the parameters of RV function after CRT. There was a statistically significant improvement in TAPSE, RV basal strain, RV fractional area, RV long axis and short axis with CRT. However, improvement in these echocardiographic parameters of RV function after CRT was not independent of baseline clinical variables but statistically dependent on age, QRS duration and baseline LVEF. © 2017 Wiley Periodicals, Inc.

Benefits of Permanent His Bundle Pacing Combined With Atrioventricular Node Ablation in Atrial Fibrillation Patients With Heart Failure With Both Preserved and Reduced Left Ventricular Ejection Fraction.

PubMed

Huang, Weijian; Su, Lan; Wu, Shengjie; Xu, Lei; Xiao, Fangyi; Zhou, Xiaohong; Ellenbogen, Kenneth A

2017-04-01

Clinical benefits from His bundle pacing (HBP) in heart failure patients with preserved and reduced left ventricular ejection fraction are still inconclusive. This study evaluated clinical outcomes of permanent HBP in atrial fibrillation patients with narrow QRS who underwent atrioventricular node ablation for heart failure symptoms despite rate control by medication. The study enrolled 52 consecutive heart failure patients who underwent attempted atrioventricular node ablation and HBP for symptomatic atrial fibrillation. Echocardiographic left ventricular ejection fraction and left ventricular end-diastolic dimension, New York Heart Association classification and use of diuretics for heart failure were assessed during follow-up visits after permanent HBP. Of 52 patients, 42 patients (80.8%) received permanent HBP and atrioventricular node ablation with a median 20-month follow-up. There was no significant change between native and paced QRS duration (107.1±25.8 versus 105.3±23.9 milliseconds, P =0.07). Left ventricular end-diastolic dimension decreased from the baseline ( P <0.001), and left ventricular ejection fraction increased from baseline ( P <0.001) in patients with a greater improvement in heart failure with reduced ejection fraction patients (N=20) than in heart failure with preserved ejection fraction patients (N=22). New York Heart Association classification improved from a baseline 2.9±0.6 to 1.4±0.4 after HBP in heart failure with reduced ejection fraction patients and from a baseline 2.7±0.6 to 1.4±0.5 after HBP in heart failure with preserved ejection fraction patients. After 1 year of HBP, the numbers of patients who used diuretics for heart failure decreased significantly ( P <0.001) when compared to the baseline diuretics use. Permanent HBP post-atrioventricular node ablation significantly improved echocardiographic measurements and New York Heart Association classification and reduced diuretics use for heart failure management in atrial fibrillation patients with narrow QRS who suffered from heart failure with preserved or reduced ejection fraction. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Ethnic differences in the association of QRS duration with ejection fraction and outcome in heart failure.

PubMed

Gijsberts, Crystel M; Benson, Lina; Dahlström, Ulf; Sim, David; Yeo, Daniel P S; Ong, Hean Yee; Jaufeerally, Fazlur; Leong, Gerard K T; Ling, Lieng H; Richards, A Mark; de Kleijn, Dominique P V; Lund, Lars H; Lam, Carolyn S P

2016-09-15

QRS duration (QRSd) criteria for device therapy in heart failure (HF) were derived from predominantly white populations and ethnic differences are poorly understood. We compared the association of QRSd with ejection fraction (EF) and outcomes between 839 Singaporean Asian and 11 221 Swedish white patients with HF having preserved EF (HFPEF)and HF having reduced EF (HFREF) were followed in prospective population-based HF studies. Compared with whites, Asian patients with HF were younger (62 vs 74 years, p<0.001), had smaller body size (height 163 vs 171 cm, weight 70 vs 80 kg, both p<0.001) and had more severely impaired EF (EF was <30% in 47% of Asians vs 28% of whites). Overall, unadjusted QRSd was shorter in Asians than whites (101 vs 104 ms, p<0.001). Lower EF was associated with longer QRSd (p<0.001), with a steeper association among Asians than whites (pinteraction<0.001), independent of age, sex and clinical covariates (including body size). Excluding patients with left bundle branch block (LBBB) and adjusting for clinical covariates, QRSd was similar in Asians and whites with HFPEF, but longer in Asians compared with whites with HFREF (p=0.001). Longer QRSd was associated with increased risk of HF hospitalisation or death (absolute 2-year event rate for ≤120 ms was 40% and for >120 ms it was 52%; HR for 10 ms increase of QRSd was 1.04 (1.03 to 1.06), p<0.001), with no interaction by ethnicity. We found ethnic differences in the association between EF and QRSd among patients with HF. QRS prolongation was similarly associated with increased risk, but the implications for ethnicity-specific QRSd cut-offs in clinical decision-making require further study. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Association of apical rocking with long-term major adverse cardiac events in patients undergoing cardiac resynchronization therapy.

PubMed

Ghani, Abdul; Delnoy, Peter Paul H M; Ottervanger, Jan Paul; Ramdat Misier, Anand R; Smit, Jaap Jan J; Adiyaman, Ahmet; Elvan, Arif

2016-02-01

Correctly identifying patients who will benefit from cardiac resynchronization therapy (CRT) is still challenging. 'Apical rocking' is observed in asynchronously contracting ventricles and is associated with echocardiographic response to CRT. The association of apical rocking and long-term clinical outcome is however unknown at present. We assessed the predictive value of left ventricular (LV) apical rocking on a long-term clinical outcome in patients treated with CRT. Consecutive heart failure patients treated with primary indication for CRT-D between 2005 and 2009 were included in a prospective registry. Echocardiography was performed prior to CRT to assess apical rocking, defined as motion of the LV apical myocardium perpendicular to the LV long axis. Major adverse cardiac event (MACE) was defined as combined end point of cardiac death and/or heart failure hospitalization and/or appropriate therapy (ATP and/or ICD shocks). All echocardiograms were assessed by independent cardiologists, blinded for clinical data. Multivariable analyses were performed to adjust for potential confounders. Two hundred and ninety-five patients with echocardiography prior to implantation were included in the final analyses. Apical rocking was present in 45% of the study patients. Apical rocking was significantly more common in younger patients, females, patients with sinus rhythm, non-ischaemic cardiomyopathy, and in patients with LBBB and wider QRS duration. During a mean clinical follow-up of 5.2 ± 1.6 years, 92 (31%) patients reached the end point of the study (MACE). Patients with MACE had shorter QRS duration, had more ischaemic cardiomyopathy, and were more often on Amiodarone. In univariate analyses, MACE was associated with shorter QRS duration, ischaemic aetiology, and the absence of apical rocking. After multivariable analyses, apical rocking was associated with less MACE (hazards ratio, HR 0.44, 95% confidence interval, CI 0.25-0.77). Apical rocking is an independent predictor of a favourable long-term outcome in CRT-D patients. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

The spatial QRS-T angle in the Frank vectorcardiogram: accuracy of estimates derived from the 12-lead electrocardiogram.

PubMed

Schreurs, Charlotte A; Algra, Annemijn M; Man, Sum-Che; Cannegieter, Suzanne C; van der Wall, Ernst E; Schalij, Martin J; Kors, Jan A; Swenne, Cees A

2010-01-01

The spatial QRS-T angle (SA), a predictor of sudden cardiac death, is a vectorcardiographic variable. Gold standard vertorcardiograms (VCGs) are recorded by using the Frank electrode positions. However, with the commonly available 12-lead ECG, VCGs must be synthesized by matrix multiplication (inverse Dower matrix/Kors matrix). Alternatively, Rautaharju proposed a method to calculate SA directly from the 12-lead ECG. Neither spatial angles computed by using the inverse Dower matrix (SA-D) nor by using the Kors matrix (SA-K) or by using Rautaharju's method (SA-R) have been validated with regard to the spatial angles as directly measured in the Frank VCG (SA-F). Our present study aimed to perform this essential validation. We analyzed SAs in 1220 simultaneously recorded 12-lead ECGs and VCGs, in all data, in SA-F-based tertiles, and after stratification according to pathology or sex. Linear regression of SA-K, SA-D, and SA-R on SA-F yielded offsets of 0.01 degree, 20.3 degrees, and 28.3 degrees and slopes of 0.96, 0.86, and 0.79, respectively. The bias of SA-K with respect to SA-F (mean +/- SD, -3.2 degrees +/- 13.9 degrees) was significantly (P < .001) smaller than the bias of both SA-D and SA-R with respect to SA-F (8.0 degrees +/- 18.6 degrees and 9.8 degrees +/- 24.6 degrees, respectively); tertile analysis showed a much more homogeneous behavior of the bias in SA-K than of both the bias in SA-D and in SA-R. In pathologic ECGs, there was no significant bias in SA-K; bias in men and women did not differ. SA-K resembled SA-F best. In general, when there is no specific reason either to synthesize VCGs with the inverse Dower matrix or to calculate the spatial QRS-T angle with Rautaharju's method, it seems prudent to use the Kors matrix. Copyright 2010 Elsevier Inc. All rights reserved.

New Features of Electrocardiogram in a Case Report of Arrhythmogenic Right Ventricular Cardiomyopathy: A Care-Compliant Article.

PubMed

Pei, Haifeng; Yu, Qiujun; Su, Xiaohua; Wang, Zhen; Zhao, Heng; Yang, Dachun; Yang, Yongjian; Li, De

2016-04-01

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a crucial health problem. With sudden death often being the first presentation, early diagnosis for ARVC is essential. Up to date, electrocardiogram (ECG) is a widely used diagnostic method without invasive harms. To diagnose and treat ARVC as well as possible, we should clearly elucidate its pathophysiological alterations. A 66-year-old farmer presented to the Emergency Department with continuous palpitation, chest tightness, profuse sweating, and nausea with no obvious predisposing causes. An ECG indicated ventricular tachycardia (VT). The patient experienced a sudden drop in blood pressure and acute confusion. After an immediate electrical conversion, his consciousness was gradually restored, and symptoms relieved. The patient was then transferred to the Department of Cardiology to receive ECG, echocardiography, coronary angiogram, biochemical assays, endocardiac tracing, and radiofrequency ablation. In the end, he was diagnosed with ARVC, evidenced by bilateral ventricle dilation and epsilon waves in leads V1-V3. Appropriate therapies were provided for this patient including pharmacological intervention and radiofrequency ablation. Although the diagnosis of ARVC is not difficult, this patient's ECG manifested several interesting features and should be further investigated: T wave inversions were found extensively in the anterior and inferior leads, revealing the involvement of bilateral ventricles; VTs with different morphologies and cycle lengths were found, and some VTs manifested the feature of irregularly irregular rhythm, reminding us to carefully differentiate some special VTs from atrial fibrillation (AF); and epsilon waves gradually appeared in leads V1-V3 and avR since the onset of ARVC. Most importantly, the epsilon waves behind QRS complex appeared in both sinus rhythm and ventricular premature beats/VT originating from cardiac apex, whereas the epsilon waves prior to QRS complex occurred in VT originating from right ventricular outflow tract (RVOT). The features of T wave inversion and epsilon wave in ECGs and the appearance of VTs with different morphologies can reflect the progression of ARVC. The position relationship between epsilon wave and QRS complex in VT depends on ventricular activation sequence, that is, the localization of epsilon wave depends on where VT is originating from.

Robust detection of heartbeats using association models from blood pressure and EEG signals.

PubMed

Jeon, Taegyun; Yu, Jongmin; Pedrycz, Witold; Jeon, Moongu; Lee, Boreom; Lee, Byeongcheol

2016-01-15

The heartbeat is fundamental cardiac activity which is straightforwardly detected with a variety of measurement techniques for analyzing physiological signals. Unfortunately, unexpected noise or contaminated signals can distort or cut out electrocardiogram (ECG) signals in practice, misleading the heartbeat detectors to report a false heart rate or suspend itself for a considerable length of time in the worst case. To deal with the problem of unreliable heartbeat detection, PhysioNet/CinC suggests a challenge in 2014 for developing robust heart beat detectors using multimodal signals. This article proposes a multimodal data association method that supplements ECG as a primary input signal with blood pressure (BP) and electroencephalogram (EEG) as complementary input signals when input signals are unreliable. If the current signal quality index (SQI) qualifies ECG as a reliable input signal, our method applies QRS detection to ECG and reports heartbeats. Otherwise, the current SQI selects the best supplementary input signal between BP and EEG after evaluating the current SQI of BP. When BP is chosen as a supplementary input signal, our association model between ECG and BP enables us to compute their regular intervals, detect characteristics BP signals, and estimate the locations of the heartbeat. When both ECG and BP are not qualified, our fusion method resorts to the association model between ECG and EEG that allows us to apply an adaptive filter to ECG and EEG, extract the QRS candidates, and report heartbeats. The proposed method achieved an overall score of 86.26 % for the test data when the input signals are unreliable. Our method outperformed the traditional method, which achieved 79.28 % using QRS detector and BP detector from PhysioNet. Our multimodal signal processing method outperforms the conventional unimodal method of taking ECG signals alone for both training and test data sets. To detect the heartbeat robustly, we have proposed a novel multimodal data association method of supplementing ECG with a variety of physiological signals and accounting for the patient-specific lag between different pulsatile signals and ECG. Multimodal signal detectors and data-fusion approaches such as those proposed in this article can reduce false alarms and improve patient monitoring.

Ventricular dysfunction in type 1 myotonic dystrophy: electrical, mechanical, or both?

PubMed

Lindqvist, P; Mörner, S; Olofsson, B O; Backman, C; Lundblad, D; Forsberg, H; Henein, M Y

2010-09-03

Myotonic dystrophy type 1 (DM1) is a systemic disease which affects the heart and may be a cause of sudden death. Conduction disturbances are the major cardiac abnormalities seen in this condition. We sought to assess electrical and mechanical cardiac functions to identify abnormalities that might explain sudden cardiac death in DM1. Thirty six patients with DM1 and 16 controls were studied using echocardiography including myocardial Doppler. ECG recordings were also obtained. Left ventricular (LV) dimensions were maintained but systolic function was reduced (p<0.001), including stroke volume (p<0.05). LV segmental myocardial isovolumic contraction time was prolonged (p<0.001) and correlated with PR interval (p<0.001). Isovolumic relaxation time was prolonged (p<0.05) and filling time was reduced (p<0.001). LV cavity was significantly asynchronous demonstrated by prolonged total isovolumic time (t-IVT) (p<0.001), high Tei index (p<0.001) and low ejection index (p<0.001). Right ventricular (RV) strain was reduced (p<0.001) as were its systolic and diastolic velocities (p<0.05 for both). 22/36 patients had prolonged LV t-IVT>12.3 s/min (upper 95% normal CI), 13 of whom had PR≥200 ms, 11 had QRS duration>120 ms (5 had combined abnormality) and the remaining 5 had neither. Over the 3 years follow up 10 patients had events, 6 of them cardiac. t-IVT was prolonged in 5/6 patients, PR interval in 4 and QRS duration in one. In DM1 patients, LV conventional measurements are modestly impaired but cardiac time relations suggest marked asynchronous cavity function. Although our findings were primarily explained on the basis of long PR interval or broad QRS duration a minority presented an evidence for myocardial cause of asynchrony rather than electrical. Early identification of such abnormalities may guide towards a need for additional electrical resynchronization therapy which may improve survival in a way similar to what has been shown in heart failure trials. Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.

Effect of spatial bias on the nonequilibrium phase transition in a system of coagulating and fragmenting particles.

PubMed

Rajesh, R; Krishnamurthy, Supriya

2002-10-01

We examine the effect of spatial bias on a nonequilibrium system in which masses on a lattice evolve through the elementary moves of diffusion, coagulation, and fragmentation. When there is no preferred directionality in the motion of the masses, the model is known to exhibit a nonequilibrium phase transition between two different types of steady state, in all dimensions. We show analytically that introducing a preferred direction in the motion of the masses inhibits the occurrence of the phase transition in one dimension, in the thermodynamic limit. A finite-size system, however, continues to show a signature of the original transition, and we characterize the finite-size scaling implications of this. Our analysis is supported by numerical simulations. In two dimensions, bias is shown to be irrelevant.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Niemi, Merja, E-mail: merja.niemi@joensuu.fi; Jänis, Janne; Jylhä, Sirpa

The high-resolution mass-spectrometric characterization, crystallization and X-ray diffraction studies of a recombinant IgE Fab fragment in complex with bovine β-lactoglobulin are reported. A D1 Fab fragment containing the allergen-binding variable domains of the IgE antibody was characterized by ESI FT–ICR mass spectrometry and crystallized with bovine β-lactoglobulin (BLG) using the hanging-drop vapour-diffusion method at 293 K. X-ray data suitable for structure determination were collected to 2.8 Å resolution using synchrotron radiation. The crystal belonged to the orthorhombic space group P2{sub 1}2{sub 1}2{sub 1}, with unit-cell parameters a = 67.0, b = 100.6, c = 168.1 Å. The three-dimensional structure ofmore » the D1 Fab fragment–BLG complex will provide the first insight into IgE antibody–allergen interactions at the molecular level.« less

The role of surface passivation in controlling Ge nanowire faceting

DOE PAGES

Gamalski, A. D.; Tersoff, J.; Kodambaka, S.; ...

2015-11-05

In situ transmission electron microscopy observations of nanowire morphologies indicate that during Au-catalyzed Ge nanowire growth, Ge facets can rapidly form along the nanowire sidewalls when the source gas (here, digermane) flux is decreased or the temperature is increased. This sidewall faceting is accompanied by continuous catalyst loss as Au diffuses from the droplet to the wire surface. We suggest that high digermane flux and low temperatures promote effective surface passivation of Ge nanowires with H or other digermane fragments inhibiting diffusion and attachment of Au and Ge on the sidewalls. Furthermore, these results illustrate the essential roles of themore » precursor gas and substrate temperature in maintaining nanowire sidewall passivation, necessary to ensure the growth of straight, untapered, <111>-oriented nanowires.« less

Multiple myeloma associated with acquired cutis laxa.

PubMed

Cho, S Y; Maguire, R F

1980-08-01

Acquired cutis laxa is a rare disorder characterized by diffuse laxity of the skin and loss of connective tissue support with involvement of the lungs, gastrointestinal tract, pelvic organs, and aorta. The case report presented herein describes a forty-six year old woman with multiple myeloma and cutis laxa. Her history included several severe allergic reactions and the gradual development of lax skin, loss of connective tissue support throughout the body, and emphysema. At autopsy, multiple myeloma, diffuse laxity of the skin, and panacinar emphysema were found. The amount of elastic fiber in the skin, lungs, and aorta was decreased and showed abnormal fragmentation. Results of direct immunofluorescence study demonstrated IgG bound to dermal elastic fibers. Speculation regarding an immunologic etiology of the elastic tissue abnormality is presented herein.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Warschkow, O.; McKenzie, D. R.; Curson, N. J.

Using density functional theory and guided by extensive scanning tunneling microscopy (STM) image data, we formulate a detailed mechanism for the dissociation of phosphine (PH{sub 3}) molecules on the Si(001) surface at room temperature. We distinguish between a main sequence of dissociation that involves PH{sub 2}+H, PH+2H, and P+3H as observable intermediates, and a secondary sequence that gives rise to PH+H, P+2H, and isolated phosphorus adatoms. The latter sequence arises because PH{sub 2} fragments are surprisingly mobile on Si(001) and can diffuse away from the third hydrogen atom that makes up the PH{sub 3} stoichiometry. Our calculated activation energies describemore » the competition between diffusion and dissociation pathways and hence provide a comprehensive model for the numerous adsorbate species observed in STM experiments.« less

VUV photo-processing of PAH cations: quantitative study on the ionization versus fragmentation processes

PubMed Central

Zhen, Junfeng; Castillo, Sarah Rodriguez; Joblin, Christine; Mulas, Giacomo; Sabbah, Hassan; Giuliani, Alexandre; Nahon, Laurent; Martin, Serge; Champeaux, Jean-Philippe; Mayer, Paul M.

2016-01-01

Interstellar polycyclic aromatic hydrocarbons (PAHs) are strongly affected by the absorption of vacuum ultraviolet (VUV) photons in the interstellar medium (ISM), yet the branching ratio between ionization and fragmentation is poorly studied. This is crucial for the stability and charge state of PAHs in the ISM in different environments, affecting in turn the chemistry, the energy balance, and the contribution of PAHs to the extinction and emission curves. We studied the interaction of PAH cations with VUV photons in the 7 – 20 eV range from the synchrotron SOLEIL beamline, DESIRS. We recorded by action spectroscopy the relative intensities of photo-fragmentation and photo-ionization for a set of eight PAH cations ranging in size from 14 to 24 carbon atoms, with different structures. At photon energies below ~13.6 eV fragmentation dominates for the smaller species, while for larger species ionization is immediately competitive after the second ionization potential (IP). At higher photon energies, all species behave similarly, the ionization yield gradually increases, leveling off between 0.8 and 0.9 at ~18 eV. Among isomers, PAH structure appears to mainly affect the fragmentation cross section, but not the ionization cross section. We also measured the second IP for all species and the third IP for two of them, all are in good agreement with theoretical ones confirming that PAH cations can be further ionized in the diffuse ISM. Determining actual PAH dication abundances in the ISM will require detailed modeling. Our measured photo-ionization yields for several PAH cations provide a necessary ingredient for such models. PMID:27212712

VUV photo-processing of PAH cations: quantitative study on the ionization versus fragmentation processes.

PubMed

Zhen, Junfeng; Castillo, Sarah Rodriguez; Joblin, Christine; Mulas, Giacomo; Sabbah, Hassan; Giuliani, Alexandre; Nahon, Laurent; Martin, Serge; Champeaux, Jean-Philippe; Mayer, Paul M

2016-05-10

Interstellar polycyclic aromatic hydrocarbons (PAHs) are strongly affected by the absorption of vacuum ultraviolet (VUV) photons in the interstellar medium (ISM), yet the branching ratio between ionization and fragmentation is poorly studied. This is crucial for the stability and charge state of PAHs in the ISM in different environments, affecting in turn the chemistry, the energy balance, and the contribution of PAHs to the extinction and emission curves. We studied the interaction of PAH cations with VUV photons in the 7 - 20 eV range from the synchrotron SOLEIL beamline, DESIRS. We recorded by action spectroscopy the relative intensities of photo-fragmentation and photo-ionization for a set of eight PAH cations ranging in size from 14 to 24 carbon atoms, with different structures. At photon energies below ~13.6 eV fragmentation dominates for the smaller species, while for larger species ionization is immediately competitive after the second ionization potential (IP). At higher photon energies, all species behave similarly, the ionization yield gradually increases, leveling off between 0.8 and 0.9 at ~18 eV. Among isomers, PAH structure appears to mainly affect the fragmentation cross section, but not the ionization cross section. We also measured the second IP for all species and the third IP for two of them, all are in good agreement with theoretical ones confirming that PAH cations can be further ionized in the diffuse ISM. Determining actual PAH dication abundances in the ISM will require detailed modeling. Our measured photo-ionization yields for several PAH cations provide a necessary ingredient for such models.

A characteristic scale for cold gas

NASA Astrophysics Data System (ADS)

McCourt, Michael; Oh, S. Peng; O'Leary, Ryan; Madigan, Ann-Marie

2018-02-01

We find that clouds of optically thin, pressure-confined gas are prone to fragmentation as they cool below ∼106 K. This fragmentation follows the lengthscale ∼cstcool, ultimately reaching very small scales (∼0.1 pc/n), as they reach the temperature ∼104 K at which hydrogen recombines. While this lengthscale depends on the ambient pressure confining the clouds, we find that the column density through an individual fragment Ncloudlet ∼ 1017 cm-2 is essentially independent of environment; this column density represents a characteristic scale for atomic gas at 104 K. We therefore suggest that 'clouds' of cold, atomic gas may, in fact, have the structure of a mist or a fog, composed of tiny fragments dispersed throughout the ambient medium. We show that this scale emerges in hydrodynamic simulations, and that the corresponding increase in the surface area may imply rapid entrainment of cold gas. We also apply it to a number of observational puzzles, including the large covering fraction of diffuse gas in galaxy haloes, the broad-line widths seen in quasar and AGN spectra and the entrainment of cold gas in galactic winds. While our simulations make a number of assumptions and thus have associated uncertainties, we show that this characteristic scale is consistent with a number of observations, across a wide range of astrophysical environments. We discuss future steps for testing, improving and extending our model.

Solution structure of biopolymers: a new method of constructing a bead model.

PubMed Central

Banachowicz, E; Gapiński, J; Patkowski, A

2000-01-01

We propose a new, automated method of converting crystallographic data into a bead model used for the calculations of hydrodynamic properties of rigid macromolecules. Two types of molecules are considered: nucleic acids and small proteins. A bead model of short DNA fragments has been constructed in which each nucleotide is represented by two identical, partially overlapping spheres: one for the base and one for the sugar and phosphate group. The optimum radius sigma = 5.0 A was chosen on the basis of a comparison of the calculated translational diffusion coefficients (D(T)) and the rotational relaxation times (tau(R)) with the corresponding experimental data for B-DNA fragments of 8, 12, and 20 basepairs. This value was assumed for the calculation D(T) and tau(R) of tRNA(Phe). Better agreement with the experimental data was achieved for slightly larger sigma = 5.7 A. A similar procedure was applied to small proteins. Bead models were constructed such that each amino acid was represented by a single sphere or a pair of identical, partially overlapping spheres, depending on the amino acid's size. Experimental data of D(T) of small proteins were used to establish the optimum value of sigma = 4.5 A for amino acids. The lack of experimental data on tau(R) for proteins restricted the tests to the translational diffusion properties. PMID:10620274

The Nonisothermal Stage of Magnetic Star Formation. I. Formulation of the Problem and Method of Solution

NASA Astrophysics Data System (ADS)

Kunz, Matthew W.; Mouschovias, Telemachos Ch.

2009-03-01

We formulate the problem of the formation and subsequent evolution of fragments (or cores) in magnetically supported, self-gravitating molecular clouds in two spatial dimensions. The six-fluid (neutrals, electrons, molecular and atomic ions, positively charged, negatively charged, and neutral grains) physical system is governed by the radiation, nonideal magnetohydrodynamic equations. The magnetic flux is not assumed to be frozen in any of the charged species. Its evolution is determined by a newly derived generalized Ohm's law, which accounts for the contributions of both elastic and inelastic collisions to ambipolar diffusion and Ohmic dissipation. The species abundances are calculated using an extensive chemical-equilibrium network. Both MRN and uniform grain size distributions are considered. The thermal evolution of the protostellar core and its effect on the dynamics are followed by employing the gray flux-limited diffusion approximation. Realistic temperature-dependent grain opacities are used that account for a variety of grain compositions. We have augmented the publicly available Zeus-MP code to take into consideration all these effects and have modified several of its algorithms to improve convergence, accuracy, and efficiency. Results of magnetic star formation simulations that accurately track the evolution of a protostellar fragment from a density sime103 cm-3 to a density sime1015 cm-3, while rigorously accounting for both nonideal MHD processes and radiative transfer, are presented in a separate paper.

Use of ion beams to simulate reaction of reactor fuels with their cladding

NASA Astrophysics Data System (ADS)

Birtcher, R. C.; Baldo, P.

2006-01-01

Processes occurring within reactor cores are not amenable to direct experimental observation. Among major concerns are damage, fission gas accumulation and reaction between the fuel and its cladding all of which lead to swelling. These questions can be investigated through simulation with ion beams. As an example, we discuss the irradiation driven interaction of uranium-molybdenum alloys, intended for use as low-enrichment reactor fuels, with aluminum, which is used as fuel cladding. Uranium-molybdenum coated with a 100 nm thin film of aluminum was irradiated with 3 MeV Kr ions to simulate fission fragment damage. Mixing and diffusion of aluminum was followed as a function of irradiation with RBS and nuclear reaction analysis using the 27Al(p,γ)28Si reaction which occurs at a proton energy of 991.9 keV. During irradiation at 150 °C, aluminum diffused into the uranium alloy at a irradiation driven diffusion rate of 30 nm2/dpa. At a dose of 90 dpa, uranium diffusion into the aluminum layer resulted in formation of an aluminide phase at the initial interface. The thickness of this phase grew until it consumed the aluminum layer. The rapid diffusion of Al into these reactor fuels may offer explanation of the observation that porosity is not observed in the fuel particles but on their periphery.

Linear Phase Sharp Transition BPF to Detect Noninvasive Maternal and Fetal Heart Rate.

PubMed

Marchon, Niyan; Naik, Gourish; Pai, K R

2018-01-01

Fetal heart rate (FHR) detection can be monitored using either direct fetal scalp electrode recording (invasive) or by indirect noninvasive technique. Weeks before delivery, the invasive method poses a risk factor to the fetus, while the latter provides accurate fetal ECG (FECG) information which can help diagnose fetal's well-being. Our technique employs variable order linear phase sharp transition (LPST) FIR band-pass filter which shows improved stopband attenuation at higher filter orders. The fetal frequency fiduciary edges form the band edges of the filter characterized by varying amounts of overlap of maternal ECG (MECG) spectrum. The one with the minimum maternal spectrum overlap was found to be optimum with no power line interference and maximum fetal heart beats being detected. The improved filtering is reflected in the enhancement of the performance of the fetal QRS detector (FQRS). The improvement has also occurred in fetal heart rate obtained using our algorithm which is in close agreement with the true reference (i.e., invasive fetal scalp ECG). The performance parameters of the FQRS detector such as sensitivity (Se), positive predictive value (PPV), and accuracy (F 1 ) were found to improve even for lower filter order. The same technique was extended to evaluate maternal QRS detector (MQRS) and found to yield satisfactory maternal heart rate (MHR) results.

[Dynamics of ECG voltage in changing gravity].

PubMed

Saltykova, M M; At'kov, O Iu; Capderou, A; Morgun, V V; Gusakov, V A; Kheĭmets, G I; Konovalov, G A; Kondratiuk, L L; Kataev, Iu V; Voronin, L I; Kaspranskiĭ, R R; Vaida, P

2006-01-01

Comparative analysis of the QRS voltage response to gravity variations was made using the data about 26 normal human subjects collected in parabolic flights (CNERS-AIRBUS A300 Zero-G, n=23; IL-76MD, n=3) and during the tilt test (head-up tilt at 70 degrees for a min and head-down tilt at-15 degrees for 5 min, n=14). Both the parabolic flights and provocative tilt tests affected R-amplitude in the Z lead. During the hypergravity episodes it was observed in 95% of cases with the mean gain of 16% and maximal--56%. On transition to the horizontal position, the Rz-amplitude showed a rise in each subject (16% on the average). In microgravity, the Rz-amplitude reduced in 95% of the observations. The voltage decline averaged 18% and reached 49% at the maximum. The head-down tilt was conducive to Rz reduction in 78% of observations averaging 2%. Analysis of the ECG records under changing gravity when blood redistribution developed within few seconds not enough for serious metabolic shifts still revealed QRS deviations associated exclusively with the physical factors, i.e., alteration in tissue conduction and distance to electrodes. Our findings can stand in good stead in evaluation of the dynamics of predictive ECG parameters during long-term experiments leading to changes as in tissue conduction, so metabolism.

Noninvasive Fetal ECG: the PhysioNet/Computing in Cardiology Challenge 2013.

PubMed

Silva, Ikaro; Behar, Joachim; Sameni, Reza; Zhu, Tingting; Oster, Julien; Clifford, Gari D; Moody, George B

2013-03-01

The PhysioNet/CinC 2013 Challenge aimed to stimulate rapid development and improvement of software for estimating fetal heart rate (FHR), fetal interbeat intervals (FRR), and fetal QT intervals (FQT), from multichannel recordings made using electrodes placed on the mother's abdomen. For the challenge, five data collections from a variety of sources were used to compile a large standardized database, which was divided into training, open test, and hidden test subsets. Gold-standard fetal QRS and QT interval annotations were developed using a novel crowd-sourcing framework. The challenge organizers used the hidden test subset to evaluate 91 open-source software entries submitted by 53 international teams of participants in three challenge events, estimating FHR, FRR, and FQT using the hidden test subset, which was not available for study by participants. Two additional events required only user-submitted QRS annotations to evaluate FHR and FRR estimation accuracy using the open test subset available to participants. The challenge yielded a total of 91 open-source software entries. The best of these achieved average estimation errors of 187bpm 2 for FHR, 20.9 ms for FRR, and 152.7 ms for FQT. The open data sets, scoring software, and open-source entries are available at PhysioNet for researchers interested on working on these problems.

A new electrocardiogram algorithm for diagnosing loss of ventricular capture during cardiac resynchronisation therapy.

PubMed

Ganière, Vincent; Domenichini, Giulia; Niculescu, Viviana; Cassagneau, Romain; Defaye, Pascal; Burri, Haran

2013-03-01

The prerequisite for cardiac resynchronization therapy (CRT) is ventricular capture, which may be verified by analysis of the surface electrocardiogram (ECG). Few algorithms exist to diagnose loss of ventricular capture. Electrocardiograms from 126 CRT patients were analysed during biventricular (BV), right ventricular (RV), and left ventricular (LV) pacing. An algorithm evaluating QRS narrowing in the limb leads and increasing negativity in lead I to diagnose changes in ventricular capture was devised, prospectively validated, and compared with two existing algorithms. Performance of the algorithm according to ventricular lead position was also assessed. Our algorithm had an accuracy of 88% to correctly identify the changes in ventricular capture (either loss or gain of RV or LV capture). The algorithm had a sensitivity of 94% and a specificity of 96% with an accuracy of 96% for identifying loss of LV capture (the most clinically relevant change), and compared favourably with the existing algorithms. Performance of the algorithms was not significantly affected by RV or LV lead position. A simple two-step algorithm evaluating QRS width in the limb leads and changes in negativity in lead I can accurately diagnose the lead responsible for intermittent loss of ventricular capture in CRT. This simple tool may be of particular use outside the setting of specialized device clinics.

Studies on deflection area vectors of QRS and T and ventricular gradient in right ventricular hypertrophy.

PubMed

Kawaguchi, Y

1985-04-01

QRS deflection area vector (Aqrs), T deflection area vector (At) and ventricular gradient (G) in right ventricular hypertrophy were studied in 53 subjects divided on the basis of cardiac catheterization data into four subgroups; normal controls, mild MS group, right ventricular pressure overload group and right ventricular volume overload group. Aqrs, At and G of the four subgroups were calculated using a microcomputer and compared. Aqrs in right ventricular pressure overload group and volume overload group was shifted to the right and slightly anteriorly from that in normal control group. At in right ventricular pressure overload group and volume overload group was shifted slightly upwards and significantly posteriorly from that in the normal control and mild MS groups. G in right ventricular pressure overload group and volume overload group was shifted to the right and significantly posteriorly from that in normal control and mild MS groups. Using multivariative analysis, we developed criteria for diagnosing right ventricular hypertrophy with At: 0.059At(Z) - 0.0145 [At] - 0.2608 less than or equal to 0. Application of this criteria achieved 82.4% (28 of 34) sensitivity in the patients with right ventricular hypertrophy and 90.9% (10 of 11) specificity in the normal control subjects.

The role of H2O in controlling the eruptive behavior observed during 2008 Chaitén eruption

NASA Astrophysics Data System (ADS)

Forte, Pablo; Castro, Jonathan

2016-04-01

Although highly explosive and with the capacity of producing impacts in a world-wide scale, the underlying mechanisms driving rhyolitic eruptions are not yet fully understood. The lower frequency of these events in comparison to intermediate composition and mafic magmatic eruptions has hampered observation-based studies of rhyolite activity in last century. But in 2008, the eruption of Chaitén volcano (Southern Chile), gave us the first view of a rhyolitic eruptive cycle, start to finish. After an initial explosive phase that lasted for 10 days, the vigour of the eruption decreased and gave way to an effusive phase that was characterized by the emplacement of a dome complex. Surprisingly, a transitional phase between them was identified, with the simultaneous occurrence of explosive and effusive activity (Pallister et al. 2013). During the eruption, vast amounts of glassy rhyolite bombs with H2O contents ranging from 0.1 to 1.58 wt. % H2O were produced (Castro et al. 2012). It is already well known that H2O is one of the main players involved in the evolution of rhyolitic systems and in the occurrence of explosive volcanic eruptions (eg. Zhang et al. 2007). In this study, we conducted 90 high-temperature, 1 atm experiments in order to constrain degassing systematics and resultant foaming/fragmentation behavior of magma residing in the last hundred meters of Chaitén's volcanic conduit. By using cylindrical cores (4 x 10 mm) drilled from obsidian bombs and lava dome samples, isothermal experiments were performed at temperatures between 740° and 1030°C among the whole range of H2O contents measured in the deposits. Due to the experimental design developed, the complete evolution of the experiments was possible to monitor through a sapphire window with high-speed and conventional video cameras. Post-experiment video analysis has revealed 3 types of behaviors of the samples: a) expansion followed by equilibrium (constant volume), b) expansion followed by shrinking and c) expansion followed by explosive fragmentation. This last behavior was identified exclusively in samples with H2O ≥ 1.2 wt.%, and at temperatures higher than 880°C. For samples with H2O < 1.2 wt.%, no fragmentation was observed, even at higher temperatures (up to 1030°C), well above the estimated pre-eruptive temperature (~825°C) of the 2008 Chaitén rhyolite (see Castro and Dingwell, 2009). In samples that did not experience fragmentation, porosities of up to 85% were measured. Experimental results show that foaming and fragmentation behaviors reflect the efficiency of degassing of the system and this in turn depends on H2O content and temperature. We show that diverse vesiculation and fragmentation behaviors are the result of a complex interplay between H2O exsolution, diffusion rates and consequent changes in viscosity. Ultimately foaming versus fragmentation behavior depends on variations in the Peclet number, which balances viscous and diffusion-controlled bubble-growth regimes.

Left bundle branch block, an old-new entity.

PubMed

Breithardt, Günter; Breithardt, Ole-Alexander

2012-04-01

Left bundle branch block (LBBB) is generally associated with a poorer prognosis in comparison to normal intraventricular conduction, but also in comparison to right bundle branch block which is generally considered to be benign in the absence of an underlying cardiac disorder like congenital heart disease. LBBB may be the first manifestation of a more diffuse myocardial disease. The typical surface ECG feature of LBBB is a prolongation of QRS above 0.11 s in combination with a delay of the intrinsic deflection in leads V5 and V6 of more than 60 ms and no septal q waves in leads I, V5, and V6 due to the abnormal septal activation from right to left. LBBB may induce abnormalities in left ventricular performance due to abnormal asynchronous contraction patterns which can be compensated by biventricular pacing (resynchronization therapy). Asynchronous electrical activation of the ventricles causes regional differences in workload which may lead to asymmetric hypertrophy and left ventricular dilatation, especially due to increased wall mass in late-activated regions, which may aggravate preexisting left ventricular pumping performance or even induce it. Of special interest are patients with LBBB and normal left ventricular dimensions and normal ejection fraction at rest but who may present with an abnormal increase in pulmonary artery pressure during exercise, production of lactate during high-rate pacing, signs of ischemia on myocardial scintigrams (but no coronary artery narrowing), and abnormal ultrastructural findings on myocardial biopsy. For this entity, the term latent cardiomyopathy had been suggested previously.

The 'fragmented' scintigraphic lung pattern in pulmonary lymphangitic carcinomatosis secondary to breast cancer.

PubMed

Vattimo, A V; Burroni, L; Bertelli, P; Vella, A; Volterrani, D

1998-01-01

Pulmonary lymphangitic carcinomatosis (PLC) is an unusual presentation of diffuse infiltrative lung disease. In this report we present two cases secondary to breast cancer; the diagnosis was made by means of transbronchial lung biopsy or postmortem examination. The goal of this study was to analyze the scintigraphic pattern of pulmonary perfusion performed with technetium-99m macroaggregated albumin (99mTc-MAA) in the hope of achieving improved recognition of PLC and its subsequent diagnosis. Upon admission, both patients underwent routine clinical exams followed by chest X-rays. The second patient also underwent CT examination, and both were ultimately examined using pulmonary perfusion scintigraphy with 99mTc-MAA. In the various exams performed, the most reliable and easily identified diagnostic finding turned out to be a characteristic 'fragmented' lung pattern revealed with the perfusion lung scan. Unfortunately, in both cases the patients' conditions rapidly worsened and death occurred shortly following scintigraphy. We were able to conclude that the recognition of the mentioned fragmented scintigraphic lung pattern may be useful in suspected PLC, whereas the nonspecific clinical presentation of this pathology makes diagnosis extremely difficult, with the most significant results being achieved through a comparison of scintigraphic and high resolution CT data.

Study on the isospin equilibration phenomenon in nuclear reactions 40Ca + 40Ca , 40Ca + 46Ti , 40Ca + 48Ca , 48Ca + 48Ca at 25 MeV/nucleon by using the CHIMERA multidetector

NASA Astrophysics Data System (ADS)

Martorana, N. S.; Auditore, L.; Berceanu, I.; Cardella, G.; Chatterjee, M. B.; De Luca, S.; De Filippo, E.; Dell'Aquila, D.; Gnoffo, B.; Lanzalone, G.; Lombardo, I.; Maiolino, C.; Norella, S.; Pagano, A.; Pagano, E. V.; Papa, M.; Pirrone, S.; Politi, G.; Porto, F.; Quattrocchi, L.; Rizzo, F.; Russotto, P.; Trifirò, A.; Trimarchi, M.; Verde, G.; Vigilante, M.

2017-11-01

We report on the results obtained by studying nuclear reactions between isotopes of Ca and Ti at 25 MeV/nucleon. We used the multidetector CHIMERA to detect charged reaction products. In particular, we studied two main effects: the isospin diffusion and the isospin drift. In order to study these processes we performed a moving-source analysis on kinetic energy spectra of the isobar nuclei ^{3H} and ^{3He} . This method allows to isolate the emission from the typical sources produced in reactions at Fermi energy: projectile like fragment (PLF), target like fragment (TLF), and mid-velocity (MV) emission. The obtained results are compared to previous experimental investigations and to simulations obtained with CoMD-II model.

Analysis of structure of hyperfine poly(3-hydroxybutyrate) fibers (PHB) for controlled drug delivery

NASA Astrophysics Data System (ADS)

Olkhov, A. A.; Kosenko, R. Yu; Markin, V. S.; Zykova, A. K.; Pantyukhov, P. V.; Karpova, S. G.; Iordanskii, A. L.

2017-12-01

Hyperfine fibers based on biodegradable poly (3-hydroxybutyrate) with encapsulated drug substance (dipyridamol) were obtained by using electrospinning method. Addition of dipyridamol has a significant effect on geometrical shape and structure of microfibers as well as total porosity of fibrous material. Observation of fibers using scanning electron microscopy (SEM) method showed that without or at lower dipyridamol content (<3%) fibers consisted of interleaved ellipsoid and cylindrical fragments. At higher dipyridamol content (3-5%) anomalous ellipsoid structures did not practically form, and fiber’s shape became cylindrical. The totality of morphological and structural characteristics determined the rate of dipyridamol diffusive transports. The simplified model of drug desorption from fibrous matrix was presented. In current work it was showed that the rate-limiting stage of transport was the diffusion of dipyridamol in the bulk of cylindrical fibers.

Micro-Raman study of isotope substitution in YBa2Cu183O6.2 during local laser annealing

NASA Astrophysics Data System (ADS)

Ivanov, V. G.; Iliev, M. N.; Thomsen, C.

1995-11-01

The local laser heating of YBa2Cu183O6.2 in air was used to study the oxygen diffusion and oxygen ordering in sample volumes of the order of a few μm3. Raman microprobe at points corresponding to different annealing temperatures was applied to monitor both the stages of substitution of 16O for 18O at different oxygen sites and the structural changes in the basal [Cu(1)-O(1)] planes occurring during the oxygen in-diffusion. The population of the O(1) sites initially results in the formation of short Cu(1)-O(1) fragments which later conjunct into long chains. The results can be applied for a better understanding of oxygen reordering processes in YBa2Cu3O7-δ during thermal treatment.

Theoretic criteria for antibody penetration into solid tumors and micrometastases.

PubMed

Thurber, Greg M; Zajic, Stefan C; Wittrup, K Dane

2007-06-01

Targeting tumors with antibody-based therapeutics is a complex task presenting multiple kinetic barriers. Antibody internalization and clearance inhibit uptake both in solid tumors, limited by tumor vascular permeability, and in micrometastases, limited by diffusion. A modeling exercise is used to introduce 2 simple criteria that must be less than unity for saturation of both tumors and micrometastases. The clearance modulus and the Thiele modulus are ratios of the plasma clearance rate and antibody catabolism, respectively, to the tumor tissue penetration rate. Even low rates of antigen internalization from constitutive membrane turnover can significantly retard antibody penetration. Rapid clearance of single-chain variable fragments also hinders uptake, often more than counterbalancing their more rapid extravasation and diffusion. The model illustrates that with the large resistance from the tumor capillary, antibodies may be more suitable for targeting micrometastases than vascularized tumors.

Confidence regions of planar cardiac vectors

NASA Technical Reports Server (NTRS)

Dubin, S.; Herr, A.; Hunt, P.

1980-01-01

A method for plotting the confidence regions of vectorial data obtained in electrocardiology is presented. The 90%, 95% and 99% confidence regions of cardiac vectors represented in a plane are obtained in the form of an ellipse centered at coordinates corresponding to the means of a sample selected at random from a bivariate normal distribution. An example of such a plot for the frontal plane QRS mean electrical axis for 80 horses is also presented.

The Potential of Micro Electro Mechanical Systems and Nanotechnology for the U.S. Army

DTIC Science & Technology

2001-05-01

Quantitative Structure Activity Relationship ( QSAR ) model . The QSAR model calculates the proper composition of the polymer-carbon black matrix...example, the BEI Gyrochip Model QRS11 from Systron Donner Inertial Division has a startup time of less than 1 second, a Mean Time Between Failure (MTBF... modeling from many equations per atom to a few lines of code. This approach is amenable to parallel processing. Nevertheless, their programs require